Variation in Physician Charges and Medicare Payments for Hand Surgery

Abstract

Purpose To assess national and state-level variation in physician charges (full amounts requested before payments are negotiated) and Medicare payments for common hand procedures.

Materials and Methods Using the Medicare Provider Utilization and Payment Data Public Use File for 2012, we evaluated national and state variations in physician charges and Medicare payments for carpal tunnel release, trigger finger release, trigger finger injection, closed treatment of distal radius fracture, and interposition arthroplasty, intercarpal or carpometacarpal joints. We assessed variation, using the coefficient of variation. We also determined the correlation between charges and payments, as well as the association of patient volume with charges and payments.

Results There was wide state-level variation in physician charges for carpal tunnel release (11-fold), trigger finger release (9.6-fold), and trigger finger injection (5.5-fold). On a national level, physician charges varied substantially for carpal tunnel release, trigger finger release, trigger finger injection, closed treatment of distal radius fracture, and interposition arthroplasty, intercarpal or carpometacarpal joints. Medicare payments varied to a lesser extent. The correlations between physician charges and Medicare reimbursements were not strong. Weak to no correlations were noted between patient volume and both charges and payments.

Conclusion Physician charges for hand surgery vary substantially across states and nationally, and they do not correlate well with Medicare payments and surgeon volume. As the health care market transitions toward more restrictive physician networks and high-deductible plans, protecting uninsured and out-of-network patients from unexpected, high medical bills should be a policy priority.

Type of Study/Level of Evidence Economic/Decision Analysis, Level III study.

Keywords

hand surgery - Medicare payments - physician charges - reimbursement

• References

• 1 Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008; 27 (03) 759-769
• 2 Whittington JW, Nolan K, Lewis N, Torres T. Pursuing the triple aim: the first 7 years. Milbank Q 2015; 93 (02) 263-300
• 3 Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. Changes in health care spending and quality 4 years into global payment. N Engl J Med 2014; 371 (18) 1704-1714
• 4 Orszag PR, Emanuel EJ. Health care reform and cost control. N Engl J Med 2010; 363 (07) 601-603
• 5 Williams JC. A systems thinking approach to analysis of the Patient Protection and Affordable Care Act. J Public Health Manag Pract 2015; 21 (01) 6-11
• 6 Stryker LS, Odum SM, Fehring TK. Variations in hospital billing for total joint arthroplasty. J Arthroplasty 2014; 29 (09) Suppl): 155-159
• 7 Li Y, Lu X, Wolf BR, Callaghan JJ, Cram P. Variation of Medicare payments for total knee arthroplasty. J Arthroplasty 2013; 28 (09) 1513-1520
• 8 Thakore RV, Greenberg SE, Bulka CM, Ehrenfeld JM, Obremskey WT, Sethi MK. Geographic variations in hospital charges and Medicare payments for major joint arthroplasty. J Arthroplasty 2015; 30 (05) 728-732
• 9 Schoenfeld AJ, Harris MB, Liu H, Birkmeyer JD. Variations in Medicare payments for episodes of spine surgery. Spine J 2014; 14 (12) 2793-2798
• 10 Goz V, Rane A, Abtahi AM, Lawrence BD, Brodke DS, Spiker WR. Geographic variations in the cost of spine surgery. Spine 2015; 40 (17) 1380-1389
• 11 Kyanko KA, Pong DD, Bahan K, Curry LA. Patient experiences with involuntary out-of-network charges. Health Serv Res 2013; 48 (05) 1704-1718
• 12 Veltre DR, Yakavonis M, Curry EJ. et al. Regional variations of medicare physician payments for hand surgery procedures in the United States. Hand (NY) 2019; 14 (02) 209-216
• 13 Brennan N, Conway PH, Tavenner M. The Medicare physician-data release-context and rationale. N Engl J Med 2014; 371 (02) 99-101
• 14 O'Gara PT. Caution advised: Medicare's physician-payment data release. N Engl J Med 2014; 371 (02) 101-103
• 15 Sun BC, Laurie A, Prewitt L, Fu R, Chang AM, Augustine J, Reese CT, McConnell KJ. (2015) Risk-Adjusted Variation of Publicly Reported Emergency Department Timeliness Measures. Ann Emerg Med 2016; 67 (04) 509-516
• 16 Yin H, Radican L, Kong SX. A study of regional variation in the inpatient cost of lower extremity amputation among patients with diabetes in the United States. J Med Econ 2013; 16 (06) 820-827
• 17 Weinstein JN, Bronner KK, Morgan TS, Wennberg JE. Trends and geographic variations in major surgery for degenerative diseases of the hip, knee, and spine. Health Aff (Millwood). 2004 ;(Suppl Variation): VAR81-VAR89
• 18 Archibald-Seiffer N, Jacobs Jr J, Zbojniewicz A, Shea K. Incarceration of the intermeniscal ligament in tibial eminence injury: a block to closed reduction identified using MRI. Skeletal Radiol 2015; 44 (05) 717-721
• 19 Robinson BR, Pritts TA, Hanseman DJ, Wilson GC, Abbott DE. Cost discrepancies for common acute care surgery diagnoses in Ohio: influences of hospital characteristics on charge and payment differences. Surgery 2014; 156 (04) 814-822
• 20 Fowler JR, Buterbaugh GA. Patient perception of physician reimbursement for common hand surgical procedures. Orthopedics 2013; 36 (09) e1149-e1154
• 21 Kokko KP, Lipman AJ, Sapienza A, Capo JT, Barfield WR, Paksima N. “Hand surgeons probably don't starve”: patient's perceptions of physician reimbursements for performing an open carpal tunnel release. Hand (NY) 2015; 10 (04) 773-778
• 22 Bai G, Anderson GF. Variation in the ratio of physician charges to medicare payments by specialty and region. JAMA 2017; 317 (03) 315-318