10.5061/DRYAD.XGXD254CR
Reynolds, Evan
0000-0002-0138-8436
University of Michigan-Ann Arbor
Kerber, Kevin
University of Michigan–Ann Arbor
Hill, Chloe
University of Michigan–Ann Arbor
De Lott, Lindsey
University of Michigan-Ann Arbor
Magliocco, Brandon
American Academy of Neurology
Esper, Gregory
Emory University
Callaghan, Brian
0000-0002-8885-6748
University of Michigan-Ann Arbor
The effects of the Medicare NCS reimbursement policy: utilization,
payments, and patient access
Dryad
dataset
2020
Medicare
reimbursement
nerve conduction studies
inappropriate testing
Health Services Research (HSR) Subcommittee of the American Academy of
Neurology (AAN) *
2021-03-16T00:00:00Z
2021-03-16T00:00:00Z
en
13520 bytes
2
CC0 1.0 Universal (CC0 1.0) Public Domain Dedication
Objective: To determine whether the 2013 nerve conduction study (NCS)
reimbursement reduction changed Medicare utilization, payments, and
patient access to Medicare physicians, we performed a retrospective
analysis of Medicare data (2012-2016 fee-for-service data from the CMS
Physician and Other Supplier Public Use File). Methods: Individual
billable services were identified by Healthcare Common Procedure Coding
System CPT and G codes. Medicare utilization and payments were stratified
by specialty and type of service (electrodiagnostic tests, including NCS
and electromyography (EMG), and other neurologic procedures). We also
assessed access to Medicare physicians using the annual number of unique
beneficiaries receiving initial Evaluation and Management (E/M) services.
Results: We identified 676,113 Medicare providers included in all
analysis years from 2012-2016 (10,599 neurologists, 5,881 physiatrists,
and 659,633 other specialties). Comparing 2016 to 2012, 21.1% fewer
neurologists, 28.6% fewer physiatrists, and 69.3% fewer other specialists
performed NCS and 3.8% fewer neurologists, 21.7% fewer physiatrists, and
5.6% fewer other specialists performed EMG. For NCS providers in 2012, the
mean number of unique Medicare beneficiaries increased for neurologists
(1.2%) and physiatrists (4.8%) but decreased for other specialists (-6.5%)
by 2016. Following the NCS cut, the number of providers performing
autonomic and evoked potential testing increased substantially.
Conclusions: The Medicare NCS reimbursement policy resulted in a larger
decrease in NCS providers than in EMG providers. Despite fewer
neurologists and physiatrists performing NCS, Medicare access to these
physicians for E/M services was not affected. Increased autonomic and
evoked potential testing may be an unintended consequence of NCS
reimbursement change.
We performed a retrospective analysis of Medicare utilization and payments
at the provider level, stratified by specialty and type of service.
Medicare Part B fee-for-service data were obtained from the publicly
available CMS Physician and Other Supplier Public Use File (POSPUF).
Individual billable services were identified by Healthcare Common
Procedure Coding System (HCPCS) Level-I CPT codes and Level-II G-codes.
This supplemental data details the specific codes used for our paper.