An Evaluation of Gynecologic Procedure Billing by Medicare

Objective: The goal of this research was to evaluate trends in gynecologic surgical reimbursement and to determine the factors affecting compensation. Materials and Methods: Procedure codes representing a comprehensive list of gynecologic surgical procedures were used to calculate the mean annual reimbursements from 2012 to 2017. Medicare compensation trends for all gynecologic procedures and trends for hysterectomies were evaluated with and without adjustment for inflation, using data from the Bureau of Labor and Statistics. The impact of the constituent components of physician billing was evaluated using linear regression. Results: Overall gynecologic surgical billing was flat with an insignificant increase of $12-$18 (2.5%-4.0%) during the study period. While the conversion factor increased significantly (5.2%) over time, the other major inputs to billing were flat. The most important determinant of compensation was the work relative value unit (wRVU). Using a regression model, a 1-point increase in the wRVU increased billing by $36.87. Laparoscopic hysterectomy reimbursement decreased significantly over time (p = 0.001). The mean reimbursement for laparoscopic hysterectomies dropped by 14.2% after changes to the relative value assignment were adjusted for these procedures. Conclusions: Gynecologic surgical reimbursement has been essentially flat over time. Reimbursement for laparoscopic hysterectomy has declined over time significantly. This inequity will only be magnified as hysterectomies shift to minimally invasive techniques. The most-effective method to maintain or improve overall gynecologic surgical compensation is to increase the assigned relative value unit for high-volume procedures such as hysterectomy.