Authors: Naresh P. Patel, MD, FAANS; Kent Richter, BS; Jack Haglin, BS; Mark Lyons, MD (Phoenix, AZ)
Introduction: Literature evaluating procedural reimbursements and national financial trends in modern neurosurgery is lacking. A comprehensive understanding of neurosurgical economic trends and financial health is important to ensure the sustained success of the specialty moving forward. This study evaluated monetary trends in Medicare reimbursement rates from 2000 to 2018 for the 10 most common spinal and cranial neurosurgical procedures. Methods: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the top 10 most utilized CPT codes in spinal and cranial neurosurgery. Comprehensive reimbursement data was extracted. The raw percent change in Medicare reimbursement rate from 2000 to 2018 was calculated for each procedure and averaged. This was compared to the percent change in the consumer price index over the same time. Data was adjusted for inflation and trend analysis performed. The average annual and the total percentage change in reimbursement were calculated based on these adjusted trends, and the compound annual growth rate was calculated for each procedure. Results: From 2000 to 2018, the average reimbursement for all procedures decreased by an average of 25.80%. The adjusted reimbursement rate for all procedures decreased by an average of 1.59% each year and experienced an average compound annual growth rate of -1.66%, indicating a steady annual decline in reimbursement when adjusted for inflation. Conclusion: This is the first study to evaluate comprehensive trends in Medicare reimbursement in neurosurgery. When adjusted for inflation, Medicare reimbursement for all included procedures has steadily decreased from 2000 to 2018, with similar rates of decline observed between cranial and spinal neurosurgery procedures. Increased awareness and consideration of these trends will be important moving forward as continued progress is made to advance agreeable reimbursement models that allow for the sustained future growth of neurosurgery in the United States.