Financial analysis of factors impacting reimbursement for abdominoplasty.
BACKGROUND
With growth in numbers of abdominoplasty procedures performed, we studied our experience with reimbursement and factors that impacted reimbursement and indirectly access to care.


METHODS
From July 2004 to June 2007, 245 patients had abdominoplasty. Demographic and financial variables were noted. Twenty different insurance plans were categorized as a single "commercial insurance" group in our analysis, and the other two study groups were "self-pay" and "Medicare" patients.


RESULTS
Of the 245 patients studied, 87 paid for surgery ("self pay"), while 134 had commercial insurance, and 24 had Medicare. One hundred sixty patients (65%) had gastric bypass surgery (gbs). Medicare paid 28% less than insurance, and insurance paid 48% less than patients who prepaid. Of the 24 Medicare patients, 16 (67%) resulted in zero payment. On multiple logistic regression analysis, BMI, gbs history, and coincident hernia repair significantly impacted payment. BMI negatively impacted reimbursement, with every unit increase in BMI leading to a 0.77 percentage point reduction in reimbursement. Coincident hernia repair was associated with 17.5 percentage points reduction in reimbursement (p = 0.002). History of gbs improved reimbursement by a factor of 11 (p = 0.01). Neither age, gender, race, nor weight of tissue removed impacted reimbursement.


CONCLUSIONS
Higher BMI and coincident hernia repair impaired reimbursement for abdominoplasty, while massive weight loss after gbs improved compensation. While having patients pay for their surgery guarantees the best reimbursement, strategies such as assuring authorization prior to surgery, which Medicare will not do, will secure better reimbursement.
Shermak
Michele A
MA
Division of Plastic Surgery and Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. masherma@jhmi.edu
Choo
Shelly
S
Mallalieu
Jessie
J
Chang
David
D
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D014481:United States; D015431:Weight Loss; D055815:Young Adult
Plast Reconstr Surg. 2004 Jul;114(1):192-9
15220592
Ann Plast Surg. 2008 May;60(5):502-4
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