Medicare Payment Trends in Pulmonology and Critical Care (2003-2024).

BACKGROUND

Pulmonology and critical care physicians provide a diverse array of vital health services in a variety of settings. Reimbursement for these services is largely determined by the Centers for Medicare & Medicaid Services reimbursement schedule, which assigns relative value units (RVUs) to each service and adjusts it with a yearly conversion factor (CF) to determine reimbursement amounts.

RESEARCH QUESTION: How have changes in RVUs of specific services and the CF affected inflation-adjusted Medicare reimbursement change from 2003 to 2024 for pulmonology and critical care?

STUDY DESIGN AND

METHODS

This study was a retrospective analysis using data from Medicare's physician fee schedule. Inflation-adjusted facility and nonfacility Medicare rates were determined from each Current Procedural Terminology code using the Consumer Price Index. Total percent change was calculated for rate, CF, and component RVUs for each year from 2003 through 2024.

RESULTS

The fields of pulmonology and critical care faced substantial cuts in reimbursement from 2003 to 2024. Overall, nonfacility rates declined less than facility rates (-39.1 ± 22.8 vs -45.4 ± 16.4; P = .003) because of more favorable reimbursement changes for bronchoscopy in nonfacility settings (-31.3 ± 25.0 vs -45.8 ± 8.5; P = .009). There was no significant difference between declines in reimbursement for different practice locations, even though RVU components increased substantially more for bronchoscopy. The uniformity of the decline in reimbursement is mostly caused by cuts to the CF.

INTERPRETATION: Our results show that Medicare reimbursement has consistently declined relative to inflation because of sustained reductions in the CF across all practice locations. Nonfacility bronchoscopy reimbursement declined the least because of increased RVUs, but still declined 31.3% relative to inflation. Pulmonary and critical care medicine decline is in line with other specialties.