Comparison of Laparoscopic Cholecystectomy Reimbursement Rate and Medical Malpractice Insurance Premium Cost Across the US 2013-2023.

Background: Within the United States (US), there has been an overall increase in cost of malpractice insurance for surgeons and decrease in federal reimbursement for surgical work. This study aims to analyze state-to-state variability to understand differences in costs relative to reimbursement for surgeons and temporal trends.

Study Design: This study uses publicly available data to conduct a cross-sectional evaluation of surgeon medical malpractice premium rates and surgical reimbursement between 2013 and 2023. Surgeon reimbursement was represented in terms of the unit reimbursement rate for laparoscopic cholecystectomy (LC). The ratio of surgeon reimbursement to malpractice cost was calculated and considered as the number of LCs required in each state to cover the cost of malpractice insurance.

Results: Inflation-adjusted reimbursement for LC decreased in all states with a mean decrease of 24%. While there was an overall decrease in inflation-adjusted medical malpractice premium cost, some states experienced an increase of up to 22% (Rhode Island) while other states experienced a decrease in cost of 62% (Oregon). For the year 2023, there was significant variability in the number of LCs needed to afford malpractice insurance premiums across states, ranging from 21 (Minnesota) to 163 (Illinois). Rhode Island experienced the greatest increase in change from 2013-2023 (63%) while Oregon experienced the greatest decrease (50%).

Conclusion: This study finds significant variation in Medicare-based surgeon compensation relative to malpractice insurance costs across the US. This discrepancy highlights the challenges faced by surgical practices due to inconsistent insurance cost and decreases in reimbursement rates.