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Declining Reimbursement For Plastic Surgery Procedures: How Did We Get Here?
Eric Lee Wan, MPH, MBA1, Jacqueline Sun, BS
2, Christian X. Lava, MS
1, Karen R. Li, BBA
1, David H. Song, MD, MBA
3.
1Georgetown University School of Medicine, Washington DC, DC, USA,
2Georgetown University, Washington DC, DC, USA,
3MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington DC, DC, USA.
PURPOSE: Centers for Medicare and Medicaid Services (CMS) reimbursement for plastic surgery procedures has not kept pace with inflation. Since the American Medical Association Relative Value Scale Update Committee (RUC) influences reimbursement rates by making recommendations to CMS, we sought to describe how RUC determines reimbursement of plastic surgery procedures.
METHODS: RUC made recommendations to CMS for 38 plastic surgery procedure codes between 2015 and 2022. We collected RUC data available for 33 codes including American Society of Plastic Surgeons (ASPS) recommendations, physician survey data, and final RUC recommendations.
RESULTS: RUC agreed with ASPS recommendations for 88% (29/33) of codes. While reviewing codes, RUC considered “compelling evidence” to include reorganization into new code families (9 codes), flawed/outdated methodology (7), change in patient population (4), and miscoding (1). RUC conducted surveys for 20 codes, with an average 4.8±2.1% response rate. Work Relative Value Units were recommended at or below the 25th percentile for 85% (17/20) of codes and were influenced by other code valuations for 70% (14/20) of codes. Average recommended change in total cost of service per code was a $16.18±27.70 decrease for facilities and a $45.05±36.08 decrease for non-facility payments.
CONCLUSION: At the RUC level, we identified potential contributors to suboptimal valuation of codes including low survey response rates, recommending RVUs in the last quartile, and recommending decreases in service costs. Fair reimbursement requires advocacy efforts by specialty societies and active participation from plastic surgeons in the RUC process.
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