1308 A Decade of Change: Trends and Disparities in Medicare Reimbursement for Deep Brain Stimulation

INTRODUCTION: Deep brain stimulation (DBS) is a vital intervention for movement disorders such as Parkinson's disease, essential tremor, and dystonia. From 2013 to 2021, Medicare expenditures increased from $586 billion to $829 billion. Despite this growth, understanding the financial trends specific to DBS is crucial for ensuring its sustainability and equitable access. METHODS: A retrospective analysis of Medicare reimbursement and charges for DBS procedures from 2013 to 2021 was conducted using data from the Centers for Medicare & Medicaid Services. Statistical significance tests compared reimbursement rates between years and geographical variability in reimbursement was also analyzed. RESULTS: The analysis showed a decline in both mean charges and Medicare payments for DBS procedures. Mean charges decreased from $4,822.26 in 2013 to $4,382.21 in 2021, while mean payments declined from $960.05 to $801.47. Despite the rise in overall Medicare expenditures, the reimbursement to charges ratio remained stable at 18-20%. Significant decreases in reimbursement were found between 2013 vs. 2019 (p=0.029) and 2013 vs. 2021 (p=0.003). Geographical analysis revealed substantial inter-state variability, with reimbursement rates ranging from 8% to 56%. The total number of DBS procedures peaked in 2019 at 7,641 but declined thereafter, likely due to the COVID-19 pandemic, with a slight recovery in 2021. CONCLUSIONS: This study highlights a concerning trend of decreasing Medicare reimbursement for DBS procedures amidst rising overall Medicare expenditures. Significant regional disparities underscore the need for policy interventions to address these financial challenges. Ensuring sustainable and equitable access to DBS treatments is crucial for advancing the field and improving patient outcomes. Further research is needed to explore underlying factors and develop strategies to mitigate their impact on clinical practice.