Han A, Carayannopoulos AG. Comprehensive Analysis of Trends in Medicare Utilization and Reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017.
PM R 2021;
14:1188-1197. [PMID:
34392617 DOI:
10.1002/pmrj.12692]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION
There is an absence of literature describing Medicare utilization by physiatrists, despite their key role in treating Medicare enrollees with qualifying disabilities and common neuromusculoskeletal conditions.
OBJECTIVE
Analyze Medicare data regarding physiatrists and their beneficiaries, services, and reimbursement, as well as trends in utilization and geographic distribution.
DESIGN AND SETTING
Retrospective analysis of publicly available Center for Medicare & Medicaid Services data for Medicare beneficiaries receiving physiatric services from 2012-2017.
MAIN OUTCOME MEASURES
After adjustment for inflation, variables assessed for changes over time included provider and beneficiary demographics, total Medicare reimbursement, and number of services provided, subsequently separated by drug and medical service metrics. Lorenz curves and Gini coefficients were computed to study reimbursement inequality. Choropleth maps were generated to assess geographic differences in physician density and reimbursement, both by state and ZIP code.
RESULTS
The number of physiatrists utilizing Medicare increased from 7230 to 7895 from 2012-2017, while the average number of unique beneficiaries per clinician remained constant (307 vs 310; P = 0.51). Beneficiaries' mean hierarchical conditions category (HCC) health risk score, normalized to 1.0 for the average beneficiary, increased significantly from 2012-2017 (1.72 vs 1.80; P < 0.01). Mean Medicare reimbursement per physiatrist decreased significantly from 2012-2017 ($131 960 vs $117 623; P < 0.001), while mean number of services remained constant (3243 vs 3077; P = 0.132). Botulinum toxin and baclofen injections were the two most reimbursed drug-related services. Gini coefficients ranged from 0.52-0.53 for 2012-2017, suggesting moderate reimbursement inequality, with the 75th percentile receiving on average 2 times the median. Both physician density and top earners were concentrated in urban and metropolitan areas.
CONCLUSIONS
Despite rising healthcare costs and increasing medical complexity of physiatrists' beneficiaries, Medicare payments have decreased over time. These trends are relevant to both providers and policy makers, particularly in light of unequal geographic distribution of physiatrists across the country. This article is protected by copyright. All rights reserved.
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