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Abstract
Objective
The objective of this study was to assess procedure markup (charge-to-cost ratio) across lung resection procedures and examine variability by geographic region.
Methods
Provider-level data for common lung resection operations was obtained from the 2015 to 2020 Medicare Provider Utilization and Payment Data datasets using HCPCS codes. Procedures studied included wedge resection, VATS and Open lobectomy, segmentectomy and mediastinal & regional lymphadenectomy. Procedure markup ratio and coefficient of variation was assessed and compared across procedure, region, and provider. The coefficient of variation, a measure of dispersion defined as the ratio of the standard deviation to the mean, was likewise compared across procedure and region.
Results
Median markup ratio across all procedures was 3.56 (IQR: 2.87 - 4.59) with right skew (mean = 4.13). Median markup ratio was 3.59 for lymphadenectomy (CoV: 0.51), 3.13 for open lobectomy (CoV:0.45), 3.55 for VATS lobectomy (CoV:0.59), 3.77 for segmentectomy (CoV: 0.74), and 3.80 for wedge resection (CoV: 0.67) Increased beneficiaries, services, and HCPCS (total) were associated with a decreased markup ratio (p <.0001). Markup ratio was highest in the Northeast at 4.14 (IQR: 3.09-5.56) and lowest in the South (MR 3.26: IQR 2.68-4.02).
Conclusion
We observe geographic variation in surgical billing for thoracic surgery.
Graphical abstract
Graphical Abstract
Keywords
GLOSSARY:
BPCI (Bundled Payments for Care Improvement), CMS (Center for Medicare & Medicaid Services), COPD (Chronic Obstructive Pulmonary Disease), CoV (Coefficient of Variation), FOIA (Freedom of Information Act), HCC risk score (Hierarchical Condition Categories), HCPC (Healthcare Common Procedure Coding System), IQR (Interquartile Range), LDCT (Low-dose CT-screening), NLST (National Lung Screening Trial), NPI (National Provider Identifier), USPSTF (US Preventive Services Task Force), VATS (Video-Assisted Thoracoscopic Surgery)Article info
Publication history
Accepted:
April 21,
2023
Received:
September 30,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosure Statement
The authors have no conflicts of interest to declare.
Funding Statement: No funds, grants, or other support was received.
Ethical Statement
The Institutional Review Board (IRB) at the Icahn School of Medicine at Mount Sinai, deemed this study as exempt research as this dataset is de-identified. Patient written consent for the publication of the study was not required. Provider-level data were pulled from the Center for Medicaid and Medicare Services Provider Utilization and Payment Data: Physician and Other Supplier' datasets from 2015 to 2020.
Identification
Copyright
© 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.
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