Cost Efficacy and Geographic Variability of Plastic Surgeons' Reimbursement Compared to Other Surgical Specialties for Procedures Commonly Reimbursed By Medicare

PURPOSE: Our changing healthcare climate has recently called for greater transparency regarding the cost of procedures. The federal government therefore now publishes a public database of physician reimbursements made to healthcare providers through the Center for Medicare and Medicaid Services (CMS), known as Provider Utilization and Payment Data Public Use Files (PUF). We analyzed this reimbursement data for any geographic or specialty-specific variation in the total cost of care (TCOC) for procedures commonly performed in plastic and reconstructive surgery (PRS). MATERIALS AND METHODS: All PRS, dermatology, otolaryngology, and orthopedic surgery providers’ reimbursement data, as reported in the CMS PUFs, was compiled. The ten most common surgical procedures performed in PRS and the ten most common PRS procedures encoded by each of the other surgical specialties (OSS) were identified by Current Procedural Terminology (CPT®) codes. The TCOC in PRS for these ten most commonly performed procedures were then compared to each of the OSS’s TCOC using two-tailed Student’s t-tests. Regional variation for the TCOC for the ten most commonly performed procedures in PRS was compared amongst four geographic areas: Northeast, South, Midwest, and West. Statistical significance was computed using a one-way ANOVA. A Levene’s test was used to confirm the homogeneity of variances, and a Welch analysis was performed to compensate for variance heterogeneity. RESULTS: Student’s t-test showed that common procedures performed by PRS were associated with a lower TCOC than if they were performed by OSS: 9/10 for dermatology (p<0.01), 3/10 for otolaryngology (p<0.05), and 2/10 for orthopedics (p<0.05). The TCOC for procedures performed by PRS compared to OSS ranged between the following percentages: 89-135% for dermatology, 98-114% for otolaryngology, and 90-120% for orthopedics. The largest differences in TCOC for PRS were seen for the following procedures: “excision of malignancy from trunk or extremity" (3.1 – 4 cm; 135%) in dermatology, “excision of facial malignancy" (2.1 – 3 cm, 114%) in otolaryngology, and “removal of devitalized tissue" (each 20 cm²; 120%). Only two procedures were performed for less TCOC by OSS: “repair of wound lesion” by dermatologists and “incision of finger tendon sheath” by orthopedists. The summative potential TCOC savings by PRS compared to OSS was $29.1 million. ANOVA analysis demonstrates a greater mean TCOC in the Northeast geographic region for 4/10 of the most commonly performed procedures by PRS (p<0.05). CONCLUSIONS: PRS appears to perform those procedures most commonly reimbursed by CMS at a lower TCOC than OSS in this global overview of the PUF. Potential cost savings for these commonly CMS-reimbursed procedures, if they had been performed by PRS, are significant. Additionally, PRS procedures performed in the Northeast are associated with a higher total regional TCOC. The potential reasons for the observed differences in TCOC between specialties include factors which define the CMS conversion factor and the procedural place of service. Further investigation is required to elucidate the elements that underpin these differences in TCOC. An assessment of surgical procedural value, a product of cost and quality, would require additional study to guide optimal specialty-specific, value-based patient care.