617 Reimbursement Rates and Characteristics of Burn and Wound Debridement, a Medicare Database Analysis

TL;DR

This study analyzes Medicare and Medicaid reimbursement trends for wound and burn debridement procedures from 2012 to 2022, revealing significant shifts in provider roles and reimbursement rates.

Contribution

The study identifies a divergence in reimbursement trends between general wound and burn-specific debridement procedures and highlights the increasing role of non-physician providers.

Findings

Reimbursements for general wound debridement increased by 152%, while burn-specific debridement reimbursements decreased by 44%.

Non-physician providers saw a 153% increase in debridement procedures, while physician procedures decreased by up to 53%.

Burn-specific debridement reimbursements show a growing gap compared to general wound debridement over time.

Abstract

Wound debridement is an integral component of treating burns, infections, and chronic wounds. Although there has been increased utilization of non-physician providers and the ability to perform debridement procedures outside of the traditional clinic office visit, it remains unclear whether this has resulted in changes in reimbursement paid out by the Medicare and Medicaid trust fund. This study aims to highlight specific trends in frequency, provider, location, and reimbursement for wound debridement in the Medicare and Medicaid population so that efforts can be made to improve access to care and affordability for historically underserved patients.

Using data from the Centers for Medicare and Medicaid Services, all claims associated with wound debridement from 2012 to 2022, including debridement for treating burns, were identified through current procedural terminology (CPT) codes. The debridement-related codes included were 11000, 11001, 11045, 11046, and 11047. The burn-related debridement codes included were 16000, 16020, 16025, 16030, 16035, 16036. Over 370,000 Medicare and Medicaid procedures were included, and counts were normalized per 100,000 claims.

Over the study period, the reimbursements for all debridement procedures increased by 120%, far outstripping Consumer Price Index inflation during the same period. However, when stratifying the reimbursement rates by whether the CPT codes are for burn-related debridement, these codes saw a 44% decrease compared to a 152% increase in general wound debridement CPTs. For all debridements, procedures performed by nurse practitioners and physician assistants have increased by 153% and 55%, respectively, while debridements performed by physicians have decreased by between 3% and 53% over the same period. When stratifying reimbursements by CPT codes and providers, a general trend emerges in burn-specific procedures where non-physician providers see increases in their reimbursements while the changes in physician reimbursement are primarily negative.

Reimbursements for burn-specific debridements demonstrate a significant divergence from generalized wound debridement CPT codes, with the gap between the two widening over time. With Reimbursement rates largely down for physician providers performing burn debridement, non-physician providers are receiving larger proportions of medicare reimbursements for most of the selected debridement procedures.

The findings suggest that increased use of non-physician providers for debridement specific for burns has reduced overall reimbursements for these procedures and a shift from physician to non-physician providers. These shifts indicate a need for further study to identify factors driving the divergence between wound and burn debridements to ensure access and affordability are maintained in clinical practice.

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