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26-07-2023 | Basic Surgery | Thoracic Oncology

Variability in Excess Lobectomy Billing Among US Thoracic Surgeons

Authors: Brian Mitzman, MD, MS, Xuechen Wang, PhD, Ben Haaland, PhD, Thomas K. Varghese Jr., MD, MS, MBA

Published in: Annals of Surgical Oncology | Issue 12/2023

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Abstract

Background

Transparency in physician billing practices in the United States is lacking. Often, charges may vary substantially between providers and excess charges may be passed on to the patient. In this study, we evaluate Medicare charges and payments for minimally invasive lobectomy to obtain a sense of national billing practices and evaluate for predictors of higher charges.

Methods

The 2018 Medicare Provider Utilization Data was queried to identify surgeons submitting charges for Video-Assisted Thoracoscopic Lobectomy. Excess charges were determined by each provider. Additional demographic variables were collected including geographic region for general surgery and cardiothoracic surgery training, years in practice, and current practice setting. A multivariate gamma regression was utilized to determine predictors of high billing practices.

Results

A total of 307 unique providers submitted charges ranging from $1,104 to $25,128 with a median of $4,265. The average Medicare Payment amount ranged from $163 to $1,409, with a median of $1,056. Male surgeons were estimated to charge 1.3 times more than female surgeons, while those in an academic setting were estimated to charge 1.4 times more than private practice (p < 0.01). Surgeons practicing in the South or West were estimated to charge 0.76 and 0.81 times as much as those practicing in the Northeast (p < 0.01).

Conclusions

Billing practices vary widely across the United States. Charges submitted to Medicare likely represent a provider’s charges across all payers. In today's healthcare economy, it is important for patients to understand the true cost of care and for providers to be mindful of reasonable and appropriate charges.
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Metadata
Title
Variability in Excess Lobectomy Billing Among US Thoracic Surgeons
Authors
Brian Mitzman, MD, MS
Xuechen Wang, PhD
Ben Haaland, PhD
Thomas K. Varghese Jr., MD, MS, MBA
Publication date
26-07-2023
Publisher
Springer International Publishing
Keyword
Basic Surgery
Published in
Annals of Surgical Oncology / Issue 12/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-13940-3

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