U.S. Surgical Practice: 23-Year Trends in Medicare Procedures and Reimbursement.

This study has two goals: first, to characterize the procedural utilization among the Medicare population for the top 10 most commonly performed procedures by the 11 largest surgical specialties from 2000 to 2022. Second, to quantify the trends in reimbursement rates for these procedures over the study period. Understanding current trends and financial forces that are impacting surgical practice is crucial for ensuring continued patient access to care. The National Surgery Quality Improvement Program (NSQIP) was queried to identify the top 10 most performed Current Procedural Terminology (CPT®) codes. The Medicare Part B National Summary File was used to quantify procedural utilization and reimbursement rate for each code annually throughout the study period. All reimbursement rates were adjusted for inflation to 2022. Linear regression models evaluated trends in procedure counts and annual inflation-adjusted reimbursement rates for each CPT code within each specialty. A total of 53, 514, 927 procedures and 58, 297, 234, 278 in reimbursements by the 11 specialties were analyzed from the CMS database from 2000 to 2022. Orthopedic surgery had the highest number of procedures (17, 271, 640), followed by general surgery (8, 963, 338), neurological surgery (5, 829, 347), cardiac surgery (5, 141, 055), and urology (5, 117, 556). The top 5 highest total reimbursed surgical specialties were orthopedic surgery (22, 353, 959, 300), cardiac surgery (7, 217, 263, 197), and neurological surgery (6, 704, 206, 592). All specialties experienced a decline in inflation adjusted reimbursement rates per procedure, with vascular surgery facing the largest decline (-43. 05%) and neurosurgery facing the least (-21. 06%). Most CPT® codes (62. 7%) showed a significant downward trend in inflation-adjusted reimbursement rates. Overall, surgical procedure volume has increased over the study period, with a sharp decline due to the COVID-19 pandemic, which gradually increased over the following two years. Reimbursement rates continue to decline across the board, with the majority of CPT® codes decreasing in value over the study period.