Two Decades of Declining Medicare Reimbursement in Cardiac Surgery.

BACKGROUND: Given the uncertainty of U.S. healthcare finances, an understanding of reimbursement trends has become increasingly important in the field of cardiac surgery. We aimed to assess Medicare reimbursement trends for common cardiac surgical procedures from 2000-2022.

METHODS: Reimbursement data was extracted from the Centers for Medicare and Medicaid Services Physician Fee Schedule Look-Up Tool over the study period for six common cardiac operations: aortic valve replacement (AVR), mitral valve repair (MVr) and replacement (MVR), tricuspid valve replacement (TVR), Bentall procedure, and coronary artery bypass grafting (CABG). Reimbursement rates were adjusted for inflation to 2022 US dollars using the Consumer Price Index. Total percent change and compound annual growth rate (CAGR) were calculated. A split-time analysis was performed to assess trends pre and post-2015. Least squares and linear regressions were performed. The R2 value was calculated for each procedure, and slope was used to determine change in reimbursements over time.

RESULTS: Inflation-adjusted reimbursement decreased by 34.1% over the study period. The overall CAGR was -1.8%. Reimbursement trends differed by procedure (p<0.001), with all reimbursements trending down (R2 >0.62), except for MVR (p=0.21) and TVR (p=0.43). CABG decreased the most (-44.4%), followed by AVR (-40.1%), MVr (-38.5%), MVR (-29.8%), Bentall procedure (-28.5%), and TVR (-25.3%). In split-time analysis reimbursement rates did not significantly change from 2000-2015 (p=0.24) but decreased significantly from 2016-2022 (p=0.001).

CONCLUSIONS: Medicare reimbursement significantly decreased for most cardiac surgical procedures. These trends justify further advocacy the Society of Thoracic Surgeons to maintain access to quality cardiac surgical care.