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State Variations in Public Payer Reimbursement for Common Plastic Surgery Procedures

Kaura, Arminder S., B.A.; Berlin, Nicholas L., M.D., M.P.H.; Momoh, Adeyiza O., M.D.; Kozlow, Jeffrey H., M.D., M.S.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1653–1661
doi: 10.1097/PRS.0000000000005013
Plastic Surgery Focus: Special Topics

Background: Existing data suggest decreased willingness of plastic surgeons to participate in Medicare and Medicaid. Significant disparities exist in Medicare and Medicaid reimbursement for various general surgical procedures. The aims of this study were to investigate variations in Medicare and Medicaid reimbursement across the nation for common plastic surgery procedures.

Methods: Medicare and Medicaid reimbursement data for 2017 were obtained by means of the Centers for Medicare & Medicaid Services and publicly available fee schedules from each state, respectively, for eight common plastic surgery procedures. The difference in Medicare and Medicaid reimbursement was calculated across all states. The difference in value ascribed to each procedure was determined by comparing the payment from each payer to the work relative value units.

Results: Medicaid reimbursement rates were significantly lower for the selected procedures, with a median national discount of −25 percent ($16.09 per work relative value unit) compared to Medicare. There were higher median rates of reimbursement per work relative value unit by Medicaid in only five states when compared to Medicare. Significant variations of more than 15 percent in the Medicaid-to-Medicare reimbursement ratios between our selected procedures were identified in 28 states.

Conclusions: Variations exist between Medicare and Medicaid reimbursement for common plastic surgery procedures. The within-state variations in Medicaid reimbursement are likely reflective of important yet nontransparent differences in determining Medicaid reimbursement. These variations likely affect access to care for underserved populations. Professional societies should continue to convey the value of these important procedures and raise awareness regarding disparities in access to care.

Rochester and Ann Arbor, Mich.

From the Oakland University William Beaumont School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan.

Received for publication October 17, 2017; accepted May 22, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Jeffrey H. Kozlow, M.D., M.S., Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-0340, jkozlow@med.umich.edu

©2018American Society of Plastic Surgeons