Abstract from the 2017 New England Society for Vascular Surgery Annual MeetingDisparity in Medicaid Physician Payments for Vascular Surgery

Medicare reimbursements are standardized nationwide on the basis of resource-dependent inputs of physician time, intensity, and practice and malpractice costs, whereas Medicaid payments are determined by individual states. Our objectives were to determine Medicaid reimbursement to physicians for common vascular procedures and to compare Medicaid payments with Medicare. Using publicly available data, we obtained Medicaid physician payments in Connecticut, Massachusetts, Maine, New Hampshire, New York, Rhode Island, and Vermont for 10 commonly performed vascular surgery procedures. Medicare physician payments for the same procedures were adjusted for regional differences using Medicare geographic payment cost indices. Descriptive statistics were calculated by state; Wilcoxon signed rank test was used to compare fees, and one-way analysis of variance was used to compare variance. Medicaid payments varied widely by state. Within individual states (except Vermont), there was no relationship between Medicaid and Medicare payments (Fig 1). Medicaid reimbursement for common vascular procedures was 20% to 75% less than Medicare, with up to a threefold variation in payment for a single procedure. Mean Medicaid payment was 40% less than Medicare (Table). The variance in payment was greatest for open abdominal aortic repair (standard deviation, $227.31) and least for femoral exposure (standard deviation, $31.86). For a Medicaid-based, frequency-weighted market basket of services, New Hampshire exhibited the lowest payments (43% Medicare) and Vermont the highest (80% Medicare; Fig 2). In most states, there is no logical relationship between Medicaid and Medicare payments. Because Medicare payments are determined by the Centers for Medicare and Medicaid Services with respect to resource-based inputs, we conclude that in most states, Medicaid payments bear no relationship to resource requirements. With Medicaid expansion, access to vascular procedures may be limited by payments insufficient to meet resource needs.TableMedicaid reimbursement for common vascular proceduresCPT codeDescriptionMean Medicaid paymentMedicare payment (national average)Difference (Medicaid gap)Average percentage paid (adjusted for GPCI)Standard deviationMultiple between highest and lowest payment34812Open femoral exposure$225.63$354.45$128.8265%$31.861.5436821Arteriovenous fistula$315.14$698.04$382.9059%$106.872.0236830Arteriovenous graft$430.46$701.98$271.5366%$115.042.3936832Arteriovenous fistula revision$427.01$795.65$368.6451%$136.913.0727590Above-knee amputation$439.76$832.98$393.2259%$125.582.0334201Femoral thrombectomy$544.29$1,083.84$539.5557%$221.502.6435301Carotid endarterectomy$665.25$1,191.15$525.9062%$124.781.7134802EVAR, one dock$771.37$1,310.30$538.9463%$131.061.6035556Femoral popliteal bypass (with vein)$858.90$1,474.67$615.7762%$171.021.6235081Open abdominal aortic aneurysm repair$995.34$1,834.27$838.9360%$227.311.74CPT, Current Procedural Terminology; EVAR, endovascular aneurysm repair; GPCI, geographic payment cost index. Open table in a new tab Fig 2Market basket Medicaid payments as a percentage of Medicare.View Large Image Figure ViewerDownload Hi-res image Download (PPT)