Medicare Reimbursement to Physicians Decreased for Common Emergency Medicine Services From 2000 to 2020

• Published in: Annals of emergency medicine Vol. 76; no. 5; pp. 615 - 620
• Main Authors: Pollock, Jordan R., Bollig, Tanner R., Haglin, Jack M., Sandefur, Benjamin J., Rappaport, Douglas E., Lindor, Rachel A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020
• Subjects: Emergency Medicine - economics; Emergency Medicine - trends; Insurance, Health, Reimbursement - trends; Medicare - economics; Medicare - trends; Physicians - economics; Physicians - trends; United States; United States
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2020.06.017

The change in reimbursement rates for emergency physician services has yet to be quantified. We attempted to fill this knowledge gap by evaluating the monetary trends in Medicare reimbursement rates over the last 20 years for the most common emergency medicine services. We obtained commonly used Current Procedural Terminology (CPT) codes in emergency medicine from the American College of Emergency Physicians website. We queried the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services for each of the included CPT codes, and we extracted reimbursement data. We adjusted all monetary data for inflation to 2020 US dollars by using changes to the United States consumer price index. Both the average annual and the total percentage change in reimbursement were calculated on the basis of these adjusted trends for all included services. Reimbursement by Medicare for the services decreased by an average of 29.13% from 2000 to 2020 after adjusting for inflation. There was a stable decline in adjusted reimbursement rates throughout the study period, with an average decrease of 1.61% each year. The largest decrease was seen for laceration repairs up to 7.5 cm, with reimbursement rates for all 4 relevant CPT codes decreasing by more than 60%. When adjusted for inflation, Medicare reimbursement declined by an average of 29% over the last 20 years for the 20 most common emergency medicine services. Knowledge of these trends is essential to address current controversies in emergency medicine billing adequately and advocate for sustainable payment system reform.