Revisiting Equity in Healthcare Spending: Variation in Reimbursement for Aortic Procedures from the Perspective of Medicare Payments.

Objective: Medicare insures over 65 million Americans and is a primary driver of private insurance reimbursement rates. However, public data shows Medicare reimbursement for comparatively complex procedures such as aortic aneurysm repair is disproportionate. Medicare reimbursement rates are multifactorial and highly localized, yet little is known about nationwide trends. Therefore, we sought to compare Medicare reimbursement for aortic surgery by geographic region and state poverty level.

Methods: Fee charged, total payment received, and Medicare payment data for aortic procedures comes from publicly available datasets. Geographic regions were determined using Center for Disease Control designations, and state level poverty statistics were obtained from published Census Bureau data. Mean fee charged, total, and Medicare payments were compared by poverty and geographic subgroup.

Results: States with the highest poverty levels received significantly lower Medicare payments when compared to states with lower poverty levels. Medicare and total payments for aortic procedures varied significantly by geographic region with Midwest and Southern states receiving lower Medicare and total payments relative to the Northeast and West. Further geographic division revealed lower Medicare payments to North Central, East South-Central, and West South-Central states with correspondingly lower total payments. Total payments were highest in the Pacific West.

Conclusions: Aortic procedures are disproportionately reimbursed from Medicare. Our results suggest that states with the highest poverty levels were paid strikingly less than other regions for complex aortic procedures. Payments also varied regionally, with Midwestern and Southern providers receiving lower reimbursement than their Northeastern and Western counterparts.