State Variation in Medicare Reimbursement for the Top 100 Cardiothoracic Surgery Procedures, 2013-2022

Objective We analyzed changes in reimbursement rates for cardiothoracic surgery procedures from 2013 to 2022 to identify interstate variance and compare changes in reimbursement between procedural groups. Methods The Center for Medicare and Medicaid Services database was analyzed to find the 100 highest-grossing cardiothoracic surgery CPT codes from 2013 to 2022. Medicare Administrative Contractor codes were utilized to identify reimbursement for each state. The payments were adjusted for inflation utilizing the consumer price index. Procedures were weighted according to revenue, and an average yearly, inflation-adjusted percent change in reimbursement was generated for each U.S. state. Procedural groups were compared using single-factor ANOVA and post-hoc tests. Results Since 2013, the inflation-adjusted Medicare reimbursement for the top cardiothoracic surgery procedures for all U.S. states and territories decreased by a yearly average of 2.67%. Puerto Rico (-0.33%), Louisiana (-1.84%), and Alabama (-1.85%) showed the smallest change. Illinois (-3.62%), Kansas (-3.40%), and Wyoming (-3.22%) had the greatest decrease in reimbursement throughout the observed period. Pacemaker and defibrillator (mean: -20.85), valvular (-22.07%), and coronary artery bypass graft (CABG) surgery (-21.99%) procedural groups demonstrated significant differences between valvular (p=0.01) or CABG (p=0.02) and pacemaker and defibrillator. Conclusions Our study confirms that reimbursement patterns vary by geographical area. Second, geographic variation suggests an incentive for physicians to practice in states with higher Medicare reimbursement. Certain procedural groups have been affected more than others. New lobbying strategies may be needed to mitigate diminishing reimbursement so that quality of care is not impacted for Medicare beneficiaries in low reimbursement states.