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MEDICARE REIMBURSEMENT FOR COMMON GENERAL SURGERY PROCEDURES HAS DECLINED OVER THE LAST DECADE
JJ Hue, JL Paukovits, K Bingmer, K Sugumar, LM Ocuin, LD Rothermel, JB Ammori, JM Winter, JM Hardacre
University Hospitals Cleveland Medical Center

Background
The Centers for Medicare and Medicaid Services (CMS) proposed significant cuts in reimbursement for operations in 2021. The cuts were mitigated by Congressís approval of a stimulus package allowing for a budget deficit; however, this identified a concerning lack of literature examining current trends in reimbursement for common general surgery procedures.

Methods
National Medicare reimbursement rates were abstracted from the CMS website from 2011-2021 based on Current Procedural Terminology codes. Open and laparoscopic cholecystectomy, appendectomy, and inguinal hernia repair reimbursement rates were analyzed. Trends in unadjusted reimbursement rates were analyzed using linear regression. Reimbursement rates were also adjusted to their value in 2021 based on United States inflation rates reported by the Consumer Price Index.

Results
There was a 16.3% increase in national inflation rates over the study period: $0.86 in 2011 is equivalent to $1.00 in 2021 (R2=0.98, p<0.001). Unadjusted reimbursement rates for open and laparoscopic inguinal hernia repair increased by 6.5% and 7.2%, respectively, from 2011 to 2021 (Open: R2=0.79, p<0.001; Laparoscopic: R2=0.82, p<0.001). There was an increase in the unadjusted reimbursement rate for an open appendectomy of 5.1% (R2=0.75, p=0.001) and 6.1% for a laparoscopic appendectomy (R2=0.76, p<0.001). Reimbursement for an open cholecystectomy increased by 4.4% over the study period (R2=0.76, p<0.001). For laparoscopic cholecystectomies, there was a 6.8% decrease in unadjusted reimbursement rates (R2=0.18, p=0.19). All reimbursement rates were then adjusted to 2021 values, based on inflation rates. Adjusted reimbursement rates for all six operations decreased from 2011 to 2021 (Figure). Laparoscopic cholecystectomy ($850.59 to $681.81, 19.8% decrease) and open cholecystectomy ($1229.48 to $1104.02, 10.2% decrease) experienced the largest decrease in adjusted reimbursement rates from 2011 to 2021.

Conclusion
Since 2011, three commonly performed general surgery operations have all seen decreases in adjusted reimbursement rates, independent of operative approach. The largest decrease in reimbursement was identified for laparoscopic and open cholecystectomies. This decrement is concerning, as over 700,000 cholecystectomies are performed annually in the United States. Awareness of the current downward trends in reimbursement rates should be a priority for surgeons and hospital systems in order to maintain sustainable and accessible general surgical care.


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