Presentation Authors: Catherine Nam*, Frances Kim, David Howard, Christopher Filson, Atlanta, GA
Introduction: In order to decrease administrative burden and costs, the Center for Medicare and Medicaid Services has proposed collapsing billing codes for level II-V office visits into a single code that would reimburse in a range between level III and IV. We evaluated the impact that such a change would have on reimbursement for urologists treating Medicare beneficiaries.
Methods: We identified urologists captured by the publicly-available Medicare Provider Payment Database and examined payments for fee-for-service beneficiaries in 2016. For each provider, the database provided demographics, ZIP code of practice, and services and average payments aggregated at service level by CPT codes. Our intervention was changing average payments for CPT 99202-99205 and CPT 99212-99215 to a single value between level III and IV for new (CPT 99203/99204) and established (CPT 99213/99214) visits. The main provider-level outcomes were (a) change in payments for office outpatient services and (b) percent change in overall reimbursement. We used bivariate statistics and linear regression models to assess association of provider factors and geography with these outcomes.
Results: We identified 8,865 urologists who received Medicare fee-for-service payments in 2016. (8.3% female; 94.5% M.D.). Median reimbursement was $175,655 (IQR $85,957-$296,916), and median payments for office visits was $50,651 (IQR $25,837-$81,073). The proposed policy would result in an estimated $16.6 million in annual savings. With the proposed change, median change in reimbursement for outpatient office visits would be -$572 (IQR -$6,108 - +$3,901). The average % change in overall reimbursement would be -1.9% (SD 7.0) (Figure). 23% of urologists would have a 5% decrease in reimbursement. Compared to male urologists, female urologists had a significantly greater decrease in reimbursement (-3.4% vs -1.8% male, p < 0.001). Non-M.D. urologists would see a greater decrease compared to those with an M.D. (-2.3% vs -1.9%, p=0.006). Providers in Hawaii saw the greatest average decrease (-5.0%), and those in South Dakota had the greatest average increase (+2.0%).
Conclusions: The Medicare proposal to collapse payments for outpatient office visits has significant and widely variable impact on reimbursement for urologists.
Source of Funding: American Cancer Society (MSRG-18-015-01-CPHPS for CPF)