What question did this study set out to answer?

Quantify the magnitude and rate of divergence between Medicare hospital diagnosis-related group payments and physician Current Procedural Terminology reimbursements across matched general surgery procedures from 2019 to 2023.

August 20, 2026Annals of Surgery

The Great Divergence: Quantifying Hospital–Physician Payment Inequity in Medicare 2019 to 2023

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Quantify the magnitude and rate of divergence between Medicare hospital diagnosis-related group payments and physician Current Procedural Terminology reimbursements across matched general surgery procedures from 2019 to 2023.
Extracted DRG and CPT payment data from the Medicare Inpatient Prospective Payment System and Physician Fee Schedule from 2019 to 2023.
Matched 16 CPT codes to corresponding MS-DRGs at maximum and minimum complexity levels, creating 31 DRG/CPT ratio time series representing 489,111 discharges.
Analyzed longitudinal payment trends using ordinary least squares regression, Mann-Kendall tests, and Sen slope estimators with Benjamini-Hochberg false discovery rate correction.
Significant increasing ratio trends occurred in 24 of 31 DRG/CPT series (77.4%) after Benjamini-Hochberg correction, while no series exhibited a significant decline.
Mean DRG-Max to CPT payment ratios increased by 23.1%, whereas mean physician CPT payments dropped by 3.5% in real terms.
Largest annual ratio increases occurred in EVAR (+4.7 points/y, P=0.021), heart transplantation (+4.0 points/y, P=0.031), and liver transplantation (+1.8 points/y, P=0.006).

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Implication

Retrospective economic analysis reveals growing hospital-to-physician reimbursement disparities for surgical procedures in Medicare, highlighting the need for payment policy alignment.

Cite This Study

Wolansky et al. (2026) studied this question.

synapsesocial.com/papers/6a86b5ff8a91293e6a1cda3c https://doi.org/10.1097/sla.0000000000007205

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Implication

Retrospective economic analysis reveals growing hospital-to-physician reimbursement disparities for surgical procedures in Medicare, highlighting the need for payment policy alignment.

The Great Divergence: Quantifying Hospital–Physician Payment Inequity in Medicare 2019 to 2023

Key Points

Discussion

Implication

Cite This Study

The Great Divergence: Quantifying Hospital–Physician Payment Inequity in Medicare 2019 to 2023

Key Points

Discussion

Implication

Cite This Study

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