Introduction: Deep Brain Stimulation (DBS) is a key treatment for movement disorders, particularly in older adults for whom Medicare is the primary payer. As DBS utilization grows, it is essential to examine Medicare’s reimbursement practices to understand the financial incentives that may promote or hinder the expansion of DBS. This study aims to explore how physician demographic and practice characteristics may impact reimbursement.
Methods: Medicare claims data for DBS procedures from 2013 to 2021 were analyzed, encompassing 2,621 entries. Key variables included Submitted Charges (ASC), Allowed Amounts (AAA), and Standardized Medicare Payments (ASP). Physicians were categorized by gender, credentials, geographic regions, and operative volume. Outliers, by charge volume, were removed, and ASP/ASC and ASP/AAA ratios were calculated.
Results: For the entire dataset, ASP/AAA ratio was 80%, consistent with the 80% coverage of physician services advertised by CMS. However, ASP/ASC ratio was 25%, indicating filed charges were substantially higher than allowed amounts for procedures. After segmenting the dataset by physician characteristics, we found reduced ASP/AAA ratios for physicians in the Northeast (74.11%) and those located in commuter regions between metropolitan centers (63.25%). Additionally, despite consistent ratios, lower payments per procedure were received by females, MD-PhDs, those practicing in rural communities, and those in the highest operative volume quartile. These groups were also found to have lower allowed amounts for procedures on average despite submitting charge claims either consistent or higher than others in their respective categories.
Conclusion : These findings suggest that while Medicare maintains its 80% reimbursement target in aggregate, significant discrepancies exist across physician profiles. Lower standardized payments for certain demographic and operative attributes raise concerns about how financial incentives may be unevenly distributed. Understanding these disparities is crucial to ensuring equitable reimbursement and supporting the sustainable growth of DBS, particularly as demand continues to rise in underserved areas and among diverse provider groups.
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