Citations

BACKGROUND: Medicare reimbursement rates have decreased across various specialties but have not yet been studied in colorectal surgery. OBJECTIVE: This study aimed to analyze Medicare reimbursement trends in colorectal surgery. DESIGN: Observational study. SETTING: The Centers for Medicare and Medicaid Services’ Physician Fee Schedule was evaluated for reimbursement data for the 20 most common colorectal surgery procedures from 2006 to 2020. MAIN OUTCOME MEASURES: Inflation-adjusted annual percentage change, compound annual growth rate, and total percentage change were the outcome measures. A subanalysis was performed comparing the changes in reimbursement between 2006 to 2016 and 2016 to 2020 because of legislative changes that went into effect in 2016. RESULTS: During the study period, the inflation-unadjusted mean Medicare reimbursement rate for the 20 most common colorectal surgery procedures increased by +15.6%. This rise was surpassed by the inflation rate of +31.3%. Consequently, the inflation-adjusted reimbursement rate decreased by –11%. The adjusted reimbursement rates decreased the most at –33.8% for a flexible colonoscopy with biopsy and increased the most at +45.3% for a diagnostic rigid proctosigmoidoscopy. Annual percentage change was –0.79%, and the compound annual growth rate was –0.98%. There was an accelerated decrease in annual reimbursement rates from 2016 to 2020 at –2.23% compared to 2006 to 2016 at –0.22% (p = 0.03). The only procedure that had an increase in adjusted reimbursement rate from 2016 to 2020 was the injection of sclerosing solution for hemorrhoids. LIMITATIONS: Only Medicare reimbursement data were analyzed. CONCLUSIONS: Medicare reimbursements for colorectal surgery procedures are decreasing at an accelerating rate. Although this study is limited to Medicare data, it still presents a representation of overall reimbursement changes because Medicare policies have a ripple effect in the commercial insurance market. It is vital to understand the financial trends to be able to structure future patient care teams and to advocate for the sustainability of colorectal surgery practices in the United States. See Video Abstract at http://links.lww.com/DCR/C136. REEMBOLSO DE MEDICARE EN CIRUGÍA COLORRECTAL: UN PROBLEMA CRECIENTE ANTECEDENTES: Las tasas de reembolso de Medicare han disminuido en varias especialidades, pero aún no han sido estudiado en cirugía colorrectal. OBJETIVO: Analizar las tendencias de reembolso de Medicare en cirugía colorrectal. DISEÑO: Estudio observacional. CONTEXTO: Se evaluó el programa de tarifas médicas de los Centros de Servicios de Medicare y Medicaid para obtener datos de reembolso de los 20 procedimientos más comunes en cirugía colorrectal entre los años 2006 y 2020. PRINCIPALES MEDIDAS DE RESULTADO: Variación porcentual anual ajustada por inflación, tasa de crecimiento anual compuesta y variación porcentual total. Se realizó un subanálisis comparando los cambios en el reembolso entre los años 2006 a 2016 y 2016 a 2020 debido a los cambios legislativos que entraron en vigencia en 2016. RESULTADOS: Durante el período de estudio, la tasa media de reembolso de Medicare sin ajuste por inflación para los 20 procedimientos más comunes en cirugía colorrectal aumentó en +15,6 %. Esta suba fue superada por la tasa de inflación del +31,3%. En consecuencia, la tasa de reembolso ajustada por inflación disminuyó un -11%. Lo máximo que disminuyeron las tasas ajustadas de reembolso fue a -33,8% para una colonoscopia flexible con biopsia y aumentaron más a +45,3% para una proctosigmoidoscopia rígida de diagnóstico. El cambio porcentual anual fue -0,79% y la tasa de crecimiento anual compuesto fue -0,98%. Hubo una disminución acelerada en las tasas de reembolso anual de 2016 a 2020 a -2,23 % en comparación con 2006 a 2016 a -0,22% (p = 0,03). El único procedimiento que tuvo un aumento en la tasa de reembolso ajustada de 2016 a 2020 fue la inyección de solución esclerosante para las hemorroides. LIMITACIONES: Solo se analizaron los datos de reembolso de Medicare. CONCLUSIONES: Los reembolsos de Medicare por procedimientos en cirugía colorrectal están disminuyendo a un ritmo acelerado. Aunque este estudio se limita a los datos de Medicare, aún presenta una representación de los cambios generales en los reembolsos, ya que las pólizas de Medicare tienen un efecto dominó en el mercado de seguros comerciales. Es fundamental comprender las tendencias financieras para poder estructurar futuros equipos de atención de pacientes y abogar por la sostenibilidad de las prácticas de cirugía colorrectal en los Estados Unidos. Consulte Video Resumen video en https://links.lww.com/DCR/C136. (Traducción—Dr. Osvaldo Gauto)

Abstract Background Atrial fibrillation (AF) pulmonary vein isolation ablation has been utilized increasingly yet variably in the USA. Purpose To identify variations in AF ablation utilization and reimbursement among Medicare beneficiaries (MB). Methodology We used a 100% sample of MB who underwent AF ablation from 2013 to 2019. We stratified data geographically (Northeast, South, West, and Midwest), identified the mean AF prevalence and the number of AF ablations per 100,000 MB, and examined the correlation between AF prevalence and ablation. We also examined the number of cardiologists performing AF ablation per 100,000 MB and the average number of AF ablation per individual cardiologist (ablation/cardiologist), as well as average submitted charge (ASC) for AF ablation. Additionally, we stratified data per urban versus rural areas as well as the gender of performing cardiologists and examined ablation/cardiologist and the ASC. Results Geographic analysis: The mean AF prevalence, the rates AF ablation per 100,000 MB, the number of cardiologists per 100,000 MB, and ablation/cardiologist have shown a steady increase in all regions across years. In all years, the mean AF prevalence was significantly different among regions with the highest prevalence in the Northeast and the lowest in the West (all P<0.001), however, there was no significant difference in the rates of AF ablation per 100,000 MB (all P≥0.056). There was significant correlation between AF prevalence and ablation only in the Midwest and the West, with 46.4% and 43.4% positive correlation respectively (P≤0.0001). The number of cardiologists performing AF ablation per 100,000 MB was not significantly different among regions in all years (All P≥0.48), however, ablation/cardiologist was significantly higher in the West and the South compared to the Northeast and the Midwest (All P<0.0001). On the contrary, the ASC has shown steady decrease in all regions. The ASC was significantly different among regions in all year (all P≤0.003) with higher ASC in the Midwest and the Northeast compared to the south and the West. Urban vs rural analysis: Ablation/cardiologist was not significantly different between urban and rural areas in all years (all P≥0.068) except in 2013 when it was significantly higher in urban areas (P=0.004). The ASC was significantly higher in rural areas only in 2015 and 2019 (P=0.037 and P=0.029 respectively) however, there was no significant difference in the rest of the years (P≥0.07). Gender analysis: Ablation/cardiologist was not significantly different between male and female cardiologists in all years (P≥0.056) except in 2017 when the average was significantly higher per male cardiologists (P=0.007). The ASC was not significantly different in all years (P≥0.362). Conclusion There are variations in AF ablation utilization and reimbursement among MB in the USA according to geographic, urban and rural regions, and the gender of performing cardiologists. Funding Acknowledgement Type of funding sources: None.

INTRODUCTION: Access to care is a predictor of health outcomes for the aged female population. The purpose of this study was to evaluate the accessibility of obstetrician–gynecologists (ob-gyns) and gynecologic oncologists to the U.S. Medicare population, over time and by state. METHODS: The supply of ob-gyns and gynecologic oncologists was extracted from the Physician and Other Supplier Public Use File (POSPUF) database of Medicare Part B claims submitted to the U.S. Centers for Medicare and Medicaid Services. This supply was compared to the number of providers normalized by the number of Original Medicare beneficiaries; values reported are providers per 100,000 beneficiaries by state from 2012 to 2019, obtained from the Kaiser Family Foundation. RESULTS: In 2019, the average number of ob-gyns per 100,000 beneficiaries across all states was 67.2 (standard deviation [SD] ±19.3), and ranged from 157.01 (District of Columbia) to 45.39 (Wyoming). The average number of gynecologic oncologists was 2.48 (SD±1.18), and ranged from 6.60 (District of Columbia) to 0.83 (Mississippi). From 2012 to 2019, the average absolute difference in number of ob-gyns across all states was −7.71±8.59 and ranged from+15.74 (Connecticut) to −37.32 (Alaska). For gynecologic oncologists, this difference was+0.10±1.04 and ranged from+5.22 (District of Columbia) to −1.84 (South Dakota). CONCLUSION: There is wide geographic variation in the accessibility and growth rate of ob-gyns and GYNONCs for the Medicare population. This provides insight into areas of the country where the supply of ob-gyns and gynecologic oncologists may not meet current and future demand.

Patient portals have been widely used by patients to enable timely communications with their providers via secure messaging for various issues including transportation barriers. The large volume of portal messages offers an invaluable opportunity for studying transportation barriers reported by patients. In this work, we explored the feasibility of cutting-edge deep learning techniques for identifying transportation issues mentioned in patient portal messages with deep semantic embeddings. The successful creation of annotated corpus and identification of 7 transportation issues showed the feasibility of this strategy. The developed annotated corpus could aid in developing an artificial intelligence tool to automatically identify transportation issues from millions of patient portal messages. The identified specific transportation issues and the analysis of patient demographics could shed light on how to reduce transportation gaps for patients.

Background Analysis of current and past reimbursement patterns for federally funded programs is crucial to develop sustainable future payment models. Methods The Centers for Medicare and Medicaid Services Physician Fee Schedule was used to evaluate 26 common ophthalmic plastic and reconstructive surgery (OPRS) procedures. From 2010 to 2019, compound annual growth rate, total percent change, and annual percent change were calculated using inflation-adjusted reimbursement rates. Centers for Medicare and Medicaid Services’ Physician/Supplier Procedure Summary was used to assess the surgical volume of the 26 procedures in ophthalmology and plastic surgery services. Results From 2010 to 2019, total billed surgical procedures in OPRS decreased by 57.0%, affecting both ophthalmologists (−54.3%) and plastic surgeons (−80.1%). Over the study period, inflation-adjusted reimbursement rates decreased by 5.6%. Compound annual growth rate was −0.66%, and annual percent change was −0.62%. From 2010 to 2013, reimbursement rates increased by 1.8% each year. In contrast, from 2013 to 2019, reimbursement rates decreased by 1.7% each year (P < 0.0001). Conclusions From 2010 to 2019, Medicare utilization has substantially declined for OPRS procedures. Inflation-adjusted Medicare reimbursement rates have decreased for the majority of common procedures since 2013. Surgeons and policymakers need to be aware of these trends to ensure future availability of subspecialty surgical services.

Background . Patients increasingly use asynchronous communication platforms to converse with care teams. Natural language processing (NLP) to classify content and automate triage of these messages has great potential to enhance clinical efficiency. We characterize the contents of a corpus of portal messages generated by patients using NLP methods. We aim to demonstrate descriptive analyses of patient text that can contribute to the development of future sophisticated NLP applications. Methods . We collected approximately 3,000 portal messages from the cardiology, dermatology, and gastroenterology departments at Mayo Clinic. After labeling these messages as either Active Symptom, Logistical, Prescription, or Update, we used NER (named entity recognition) to identify medical concepts based on the UMLS library. We hierarchically analyzed the distribution of these messages in terms of departments, message types, medical concepts, and keywords therewithin. Results . Active Symptom and Logistical content types comprised approximately 67% of the message cohort. The “Findings” medical concept had the largest number of keywords across all groupings of content types and departments. “Anatomical Sites” and “Disorders” keywords were more prevalent in Active Symptom messages, while “Drugs” keywords were most prevalent in Prescription messages. Logistical messages tended to have the lower proportions of “Anatomical Sites,”, “Disorders,”, “Drugs,”, and “Findings” keywords when compared to other message content types. Conclusions . This descriptive corpus analysis sheds light on the content and foci of portal messages. The insight into the content and differences among message themes can inform the development of more robust NLP models.

AbstractObjectiveThe content of websites for fellowship programs is an important source of information for residents applying to breast imaging fellowship programs (BIFPs). The purpose of this study is to evaluate the comprehensiveness of online content of BIFPs.MethodsA list of BIFPs was obtained from the Society of Breast Imaging website. Each program’s website was evaluated for the presence of 19 training-relevant content variables. Impact of program characteristics on comprehensiveness scores was determined. For statistical analysis, Kruskal–Wallis tests were used to assess differences in comprehensiveness scores based upon region, and two-tailed t-tests were used to compare based upon program size.ResultsA total of 79 BIFP websites were analyzed. The mean comprehensiveness score of BIFP websites based on meeting the 19 criteria was 44.1% (8.4 ± 2.7/19). Program coordinator contact information (72/79, 91.1%), application requirements (71/79, 89.9%), and faculty information (56/79, 70.9%) appeared on &gt;70% of websites. The majority of fellowships had a dedicated webpage for their program (71/79, 89.9%). Information regarding 12 of the 19 criteria appeared on fewer than 50% of websites. Program region (P = 0.32) and size (P = 0.16) were not associated with any differences in mean comprehensiveness score. Additionally, there was no significant difference in scores associated with filling all available positions for the 2020 match cycle (P = 0.77).ConclusionThere is a paucity of information commonly sought out by applicants on the websites of most BIFPs. Both programs and applicants may mutually benefit from increasing comprehensive online content.