Hi, my name is Jordan Pollack. I'm a first-year medical student at Mayo Clinic. The title of our project is Medicare Reimbursement for Services Billed by Neurosurgeons from 2010 to 2018. We do not have any disclosures. The purpose of our study is to analyze Medicare reimbursement trends for services billed by neurosurgeons, such as physician charge amount and Medicare payment amount from 2010 to 2018. To understand our results, it is necessary to understand how physicians are paid by Medicare. First of all, the physician submits a charge to Medicare. Medicare sees the charge amount but does not allow physicians to charge whatever they want. Medicare only allows a certain charge amount. Generally, the allowed rate is about 20% of the charge amount. Lastly, Medicare then pays around 80% of the allowed amount to the provider. Unless Medicare denies the payment, then the provider gets nothing, of course. The methods of our study, we use the Centers of Medicare and Medicare website, which is just publicly available data. And we use the file called the physician supplier file, which is a very useful file. It contains service count, physician charge amount, Medicare payment amount, and it's just a very useful file to analyze reimbursement trends for different procedures. And in this case, we did all procedures performed by neurosurgeon physicians. Great. So the results of our study are here. As you can see, in 2010, the mean neurosurgeon charge was $860. Medicare allowed from that amount, they only allowed $167. So that's that 80% difference there around that. The mean neurosurgeon payment was $131, which means the percent paid to the original charge was about 15%. So neurosurgeons get about 15% of what they asked for originally from Medicare. In 2018, the neurosurgeon charge increased to $1,152. The allowed amount was $207. The neurosurgeon payment was $159, which results in a 13.8% paid of the original charge. So as you can see, the mean neurosurgeon charge is increasing while the percent paid to the original charge is decreasing. So physicians are asking for more, but getting less of what they asked for every year. A continuation of our results show the number of services was pretty consistent across both years at about 4 million a year. However, the denied services has increased. So there was 730,000 denied services in 2010, but in 2018, there was 830,000. So it's about 100,000% increase, almost more than 10% increase in denied services. And that's reflected in our results here. So number of services denied by Medicare was 18.3% in 2010, and in 2018, it was 21.3%. Great. As seen in our results, Medicare is paying a smaller portion of the submitted payment amount each year. In an attempt to maintain reimbursement levels, physicians increased their initial charge amount submitted to Medicare. This is a well-known phenomenon, and it can be detrimental to underinsured patients as they often receive the full amount of the physician charge amount. Additionally, Medicare is denying an increasing amount of services bowed by neurosurgeons. This could be due to incomplete patient charts, inappropriate utilization of interventions, more strict billing requirements, and others. These trends are extremely important as Medicare is the largest healthcare provider in the United States, healthcare insurer in the United States, and has a profound influence on other insurances. From 2010 to 2018, neurosurgeons are billing for higher amounts, and Medicare is paying a smaller proportion of the billed amount each year. Additionally, Medicare is denying an increasing amount of services billed by neurosurgeons. A comprehension of these trends, as seen in our study, is necessary to ensure continued access of neurosurgery care to Medicare patients. Great, and that's it. Thank you very much.

Medicare reimbursement trends

neurosurgeons

Medicare

charge amount

denied services