Unveiling the Hidden Discrepancies Between Medicare Physician Reimbursement Rates and Inflation Across Different Surgical Specialties.

OBJECTIVE: This study aimed to analyze the trends of Medicare physician reimbursement from 2011 to 2021 and compare the rates across different surgical specialties. BACKGROUND: Knowledge of Medicare is essential because of its significant contribution in physician reimbursements. Previous studies across surgical specialties have demonstrated that Medicare, despite keeping up with inflation in some areas, has remained flat when accounting for physician reimbursement. STUDY DESIGN: The Physician/Supplier Procedure Summary data for the calendar year 2021 were queried to extract the top 50% of Current Procedural Terminology codes based on case volume. The Physician Fee Schedule look-up tool was accessed, and the physician reimbursement fee was abstracted. Weighted mean reimbursement was adjusted for inflation. Growth rate and compound annual growth rate were calculated. Projection of future inflation and reimbursement rates were also calculated using the US Bureau of Labor Statistics. RESULTS: After adjusting for inflation, the weighted mean reimbursement across surgical specialties decreased by -22.5%. The largest reimbursement decrease was within the field of general surgery (-33.3%), followed by otolaryngology (-31.5%), vascular surgery (-23.3%), and plastic surgery (-22.8%). There was a significant decrease in median case volume across all specialties between 2011 and 2021 (P < 0.001). CONCLUSIONS: This study demonstrated that, when adjusted for inflation, over the study period, there has been a consistent decrease in reimbursement for all specialties analyzed. Awareness of the current downward trends in Medicare physician reimbursement should be a priority for all surgeons, as means of advocating for compensation and to maintain surgical care feasible and accessible to all patients.

Reflections on teaching and learning during the omicron wave of the COVID-19 pandemic and economic inflation.

The pandemic and the rising living costs have affected teaching and learning practices. These changes have impacted teaching faculty and students alike. This article is an analytical reflection of our experiences of teaching and learning during the omicron wave of the pandemic and rising economic inflation. This paper highlights some of our key observations. The reflective process has challenged some of our preconceptions. It has also helped highlight some questions and contradictions on teaching and learning in this context which may provide a reference for future research.

Cosmological inflation and meta-empirical theory assessment.

I apply Dawid's Meta-Empirical Assessment (MEA) methodology to the theory of cosmological inflation. I argue that applying this methodology does not currently offer a compelling case for ascribing non-empirical confirmation to cosmological inflation. In particular, I argue that despite displaying strong instances of Unexpected Explanatory Coherence (UEA), it is premature to evaluate the theory on the basis of the No Alternatives Argument (NAA). More significantly though, I argue that the theory of cosmological inflation fails to sustain a convincing Meta-Inductive Argument (MIA) because the empirical evidence and theoretical successes that it seeks to draw meta-empirical support from do not warrant a meta-inductive inference to inflation. I conclude by assessing how future developments could pave the way towards crafting a more compelling case for the non-empirical confirmation of cosmological inflation.

Self-reported Impacts of the COVID-19 Pandemic and Economic Inflation on the Well-being of Low-income U.S. Veterans.

The health and well-being of low-income populations may be disproportionately impacted by major public health and economic events. This study examined written self-reported impacts of the Coronavirus Disease-2019 (COVID-19) pandemic and the economic inflationary period on health from a national sample of 854 low-income U.S. veterans. Responses were analyzed using rapid assessment procedures. In response to the COVID-19 pandemic, 59% of participants reported the pandemic had "no effect" on their health, 7% reported increased social isolation, and small proportions of participants reported negative effects on physical and mental health. In response to economic inflation, 43% of participants reported inflation had "no effect" on their health, 11% reported concerns about personal finances, and only small proportions reported other negative psychosocial impacts. Collectively, these findings suggest many low-income veterans are resilient during major events. Further research is needed on long-term health effects of inflation on this population.

Procedure Reimbursement, Inflation, and the Declining Buying Power of the Vascular Surgeon (2011-2021).

PURPOSE: The purpose of this study was to evaluate trends in Medicare reimbursement for common vascular procedures over the last decade. To enrich the context of this analysis, vascular procedure reimbursement is directly compared to inflation-adjusted changes in other surgical specialties. METHODS: The Centers for Medicare & Medicaid Services Physician/Supplier Procedure Summary file was utilized to identify the 20 procedures most commonly performed by vascular surgeons from 2011-2021. A similar analysis was performed for orthopedic, general, and neurological surgeons. The Centers for Medicare & Medicaid Services Physician-Fee Schedule Look-Up Tool was queried for each procedure, and reimbursement data was extracted. All monetary data was adjusted for inflation to 2021 dollars utilizing the consumer price index. Average year-over-year and total percentage change in reimbursement were calculated based on adjusted data for included procedures. Comparisons to other specialty data were made with ANOVA. RESULTS: From 2011-2021, the average, unadjusted change in reimbursement for vascular procedures was -7.2%. Accounting for inflation, the average procedural reimbursement declined by 20.1%. The greatest decline was observed in phlebectomy of varicose veins (-50.6%). Open arteriovenous fistula revision was the only vascular procedure with an increase in inflation-adjusted reimbursement (+7.5%). Year-over-year, inflation-adjusted reimbursement for common vascular procedures decreased by 2.0% per year. Venous procedures experienced the largest decrease in average adjusted reimbursement (-42.4%), followed by endovascular (-20.1%) and open procedures (-13.9%). These changes were significantly different across procedural subgroups (P < 0.001). During the same period, the average adjusted change in reimbursement for the 20 most common procedures in orthopedic surgery, general surgery, and neurosurgery was -11.6% vs. -20.1% for vascular surgery (P = 0.004). CONCLUSION: Medicare reimbursement for common surgical procedures has declined over the last decade. While absolute reimbursement has remained relatively stable for several procedures, accounting for a decade of inflation demonstrates the true diminution of buying power for equivalent work. The most alarming observation is that vascular surgeons have faced a disproportionate decrease in inflation-adjusted reimbursement in comparison to other surgical specialists. Awareness of these trends is a crucial first step towards improved advocacy and efforts to ensure the "value" of vascular surgery does not continue to erode.

Adjusting for Inflation and Currency Changes Within Health Economic Studies.

OBJECTIVES: Within health economic studies, it is often necessary to adjust costs obtained from different time periods for inflation. Nevertheless, many studies do not report the methods used for this in sufficient detail. In this article, we outline the principal methods used to adjust for inflation, with a focus on studies relating to healthcare interventions in low- and middle-income countries. We also discuss issues relating to converting local currencies to international dollars and US$ and adjusting cost data collected from other countries or previous studies. METHODS: We outlined the 3 main methods used to adjust for inflation for studies in these settings: exchanging the local currency to US$ or international dollars and then inflating using US inflation rates (method 1); inflating the local currency using local inflation rates and then exchanging to US$ or international dollars (method 2); splitting the costs into tradable and nontradable resources and using method 1 on the tradable resources and method 2 on the nontradable resources (method 3). RESULTS: In a hypothetical example of adjusting a cost of US$100 incurred in Vietnam from 2006 to 2016 prices, the adjusted cost from the 3 methods were US$116.84, US$172.09, and US$161.04, respectively. CONCLUSIONS: The different methods for adjusting for inflation can yield substantially different results. We make recommendations regarding the most appropriate method for various scenarios. Moving forward, it is vital that studies report the methodology they use to adjust for inflation more transparently.

Estimated Medicare Part B Savings From Inflationary Rebates.

This study uses annual Medicare Part B spending data to examine the potential savings from the drug pricing reforms in the Inflation Reduction Act of 2022.

The Inflation Reduction Act and Access to High-Cost Cardiovascular Therapies.

This Viewpoint discusses how the price negotiation for certain drugs under the Inflation Reduction Act will provide a unique opportunity to enhance access to therapies for older patients with cardiovascular conditions and diabetes.

[Healthcare expenditures and the role of demografic change : An analysis of statutory health insurance data]. / Gesundheitsausgabenentwicklung und der Einfluss des demografischen Wandels : Eine Analyse von Daten der Gesetzlichen Krankenversicherung.

The development of healthcare expenditures and the impact of demographic change are the subject of a controversial debate. Yearly healthcare expenditures have more than doubled between 1992 and 2015 and are often justified by the aging demographic. The majority of expenses are paid by the statutory health insurance (SHI). The aim of the current study was to evaluate the contribution of the demographic change to increasing total per capita expenditures in the SHI as well as to analyze the development and the impact in individual areas of spending.We calculated average per capita expenditures from 2004 to 2015 based on data from the German Federal (Social) Insurance Office. Information on the age distribution in SHI was derived from official statistics of the Federal Ministry of Health. To determine the impact of demographic change on per capita expenditures, age distribution was standardized based on 2004 data. Additionally, the impact of inflation and other factors was determined.The results show an increase in per capita expenditures from €1722 in 2004 to €2656 in 2015 (+54.2%). Assuming a constant age distribution at the 2004 level, average per capita expenditures would have increased by 44.9%. The relative share of demographic change is only 17.3%; 32.2% could be explained by inflation and 50.5% are based on other factors. We observed large differences in the increase for the individual areas of spending, which can partly be explained by the impact of demographic change.This analysis illustrates that the demographic change is not the frequently claimed cost driver in healthcare. Other factors have a substantially greater impact on healthcare expenditures.

Reimbursement in hospital-based vascular surgery: Physician and practice perspective.

OBJECTIVE: The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. METHODS: Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care. Adjustments were made for work performed, case complexity, and inflation. To reflect the effect of these variables, net revenue was indexed to work relative value units (wRVUs), case mix index, and consumer price index, which adjusted for work, case complexity, and inflation, respectively. Differences in physician and hospital net revenue were compared over time. RESULTS: Physician work, measured in RVUs per year, increased by 4%; case complexity, assessed with case mix index, increased by 10% for the 6-year measurement period. Despite stability in payer mix at 64% to 69% Medicare, both physician and hospital vascular-related revenue/wRVU decreased during this period. Unadjusted professional revenue/wRVU declined by 14.1% (P = .09); when considering case complexity, physician revenue/wRVU declined by 20.6% (P = .09). Taking into account both case complexity and inflation, physician revenue declined by 27.0% (P = .04). Comparatively, hospital revenue for vascular surgery services decreased by 13.8% (P = .07) when adjusting for unit work, complexity, and inflation. CONCLUSIONS: At medical centers where vascular surgeons are hospital based, vascular care reimbursement decreased substantially from 2010 to 2015 when case complexity and inflation were considered. Physician reimbursement (professional fees) decreased at a significantly greater rate than hospital reimbursement for vascular care. This trend has significant implications for salaried vascular surgeons in hospital-based settings, where the majority of revenue generated by vascular surgery care is the technical component received by the facility. Appropriate care for patients with vascular disease is increasingly resource intensive, and as a corollary, reimbursement levels must reflect this situation if high-quality care is to be maintained.

Predicting Productivity Returns on Investment: Thirty Years of Peer Review, Grant Funding, and Publication of Highly Cited Papers at the National Heart, Lung, and Blood Institute.

There are conflicting data about the ability of peer review percentile rankings to predict grant productivity, as measured through publications and citations. To understand the nature of these apparent conflicting findings, we analyzed bibliometric outcomes of 6873 de novo cardiovascular R01 grants funded by the National Heart, Lung, and Blood Institute (NHLBI) between 1980 and 2011. Our outcomes focus on top-10% articles, meaning articles that were cited more often than 90% of other articles on the same topic, of the same type (eg, article, editorial), and published in the same year. The 6873 grants yielded 62 468 articles, of which 13 507 (or 22%) were top-10% articles. There was a modest association between better grant percentile ranking and number of top-10% articles. However, discrimination was poor (area under receiver operating characteristic curve [ROC], 0.52; 95% confidence interval, 0.51-0.53). Furthermore, better percentile ranking was also associated with higher annual and total inflation-adjusted grant budgets. There was no association between grant percentile ranking and grant outcome as assessed by number of top-10% articles per $million spent. Hence, the seemingly conflicting findings on peer review percentile ranking of grants and subsequent productivity largely reflect differing questions and outcomes. Taken together, these findings raise questions about how best National Institutes of Health (NIH) should use peer review assessments to make complex funding decisions.