Billing and Utilization Trends for Hand Surgery Indicate Worsening Barriers to Accessing Care

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Abstract
Background: Hospitals and providers may increase hand surgery charges to compensate for decreasing reimbursement. Higher charges, combined with increasing utilization of ambulatory surgical centers (ASCs), may threaten the accessibility of affordable hand surgery care for uninsured and underinsured patients. Methods: We queried the Physician/Supplier Procedure Summary to collect the number of procedures, charges, and reimbursements of hand procedures from 2010 to 2019. We adjusted procedural volume by Medicare enrollment and monetary values to the 2019 US dollar. We calculated weighted means of charges and reimbursement that were then used to calculate reimbursement-to-charge ratios (RCRs). We calculated overall change and r 2 from 2010 to 2019 for all procedures and stratified by procedural type, service setting, and state where service was rendered. Results: Weighted mean charges, reimbursement, and RCRs changed by + 21.0% (from $1,227 to $1,485; r 2 = 0.93), +10.8% (from $321 to $356; r 2 = 0.69), and -8.4% (from 0.26 to 0.24; r 2 = 0.76), respectively. The Medicare enrollment-adjusted number of procedures performed in ASCs increased by 63.8% ( r 2 = 0.95). Trends in utilization and billing varied widely across different procedural types, service settings, and states. Conclusions: Charges for hand surgery procedures steadily increased, possibly reflecting an attempt to make up for reimbursements perceived to be inadequate. This trend places uninsured and underinsured patients at greater risk for financial catastrophe, as they are often responsible for full or partial charges. In addition, procedures shifted from inpatient to ASC setting. This may further limit access to affordable hand care for uninsured and underinsured patients.

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