Examining Trends for Medicare Reimbursement in Emergency Care Services

According to a recent study published in Annals of Emergency Medicine, reimbursement for common emergency medicine services decreased for physicians in the last 20 years.

Jordan R Pollock, BS, Mayo Clinic Alix School of Medicine, Scottsdale, Mayo Clinic, AZ, and colleagues, examined the change in reimbursement rates for emergency physician services by evaluating the monetary trends of the most common emergency services between the years 2000 and 2020.

Data was obtained using current emergency medicine procedural terminology (CPT) codes in from the American College of Emergency Physicians. The researchers then input the CPT codes using the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services, and extracted reimbursement data. All monetary data was adjusted to reflect inflation to 2020 US dollars and the total percentage change in reimbursement were calculated on the basis of these adjusted trends for all included services, explained researchers.

According to the findings, reimbursement for the most common services decreased by an average 29.13% in the last two decades. The results also show a steady decrease for adjusted reimbursement rates for the study timeline—averaging a 1.61% decline each year.

Laceration repairs, up to 7.5cm, were recorded with the highest declination rates, with the top 4 relevant CPT codes decreasing by more than 60%. 

“Knowledge of these trends is essential to address current controversies in emergency medicine billing adequately and advocate for sustainable payment system reform,” researchers concluded.

—Edan Stanley

Reference:

Pollock JR, Bollig TR, Haglin JM, et al. Medicare reimbursement to physicians decreased for common emergency medicine services from 2000 to 2020. Ann Emerg Med. 2020 Nov;6(5): 621-624. doi.org/10.1016/j.annemergmed.2020.06.017