Results of continual devaluation of cardiothoracic surgical codes by the HCFA between 1984 and 1999

Background. The devaluation of surgical procedural services by Medicare beg an in 1989 as a result of the federal government's adoption of the Resource Based Relative Value Scale, a method of redistribution of payments to phys icians from surgical to primary care services. This method gave to the Heal th Care Financing Administration (HCFA) effective and complete control of M edicare payments to physicians for the first time. The resultant decrease i n the nominal dollar value is well understood, but the effect of changes in inflation frequently is not calculated into the reported loss. Methods. A method of determining the true extent of this devaluation using the nominal dollar decrease plus the effect of inflation was presented in 1 995. Results. Since then, repeated devaluation by the HCFA and other third parti es plus continual inflation has further eroded the remuneration for cardiot horacic surgical services. Three different sets of data are used to determi ne the devaluation of five cardiothoracic operations. One set shows the cha nge between 1988 and 1998; one the change between 1988 and 1999; and one th e change between 1984 and 1999. Conclusions. Depending on the geographic location, it appears that the remu neration for pulmonary procedures between 1988 and 1999 decreased 35% to 60 %. Similarly, depending on the years reviewed (between 1984 and 1999) and t he geographic location, the fee for cardiac procedures decreased 46% to 69% . (Ann Thorac Surg 2001;71:9-13) (C) 2001 by The Society of Thoracic Surgeo ns.