Does Fee-for-Service Medicare Reimbursement Incentivize Volume Over Value Among Oral and Maxillofacial Surgeons?

Purpose: National health care payment models have begun transitioning from fee-for-service to value-based reimbursement because of criticism of the former incentivizing quantity over quality. However, there has yet to be an evaluation of the influence of fee-for-service incentives among oral and maxillofacial surgery services. This study characterized service intensity among oral and maxillofacial surgeons (OMSs) serving Medicare beneficiaries in 2017 to determine if higher Medicare income among OMSs arises from higher service intensity or a higher volume of patients treated.

Patients And Methods: This cross-sectional study was composed of Medicare Provider Utilization and Payment Data from 2017. Providers were included if their specialty type was listed as "maxillofacial surgery." The predictor variables included service intensity, defined as the number of health care services administered per Medicare beneficiary, and Medicare beneficiary volume. The primary outcome variable was Medicare income. Descriptive statistics and pair-wise comparisons were computed at an α level of .05.

Results: The analysis cohort was composed of 696 distinct OMSs. A total of 69,959 services were recorded for 53,245 Medicare beneficiaries, with a mean service intensity of 1.12 services per beneficiary. A statistically significant difference in service intensity was found between Medicare payment deciles (P = .002). The magnitude of this difference was less relative to the difference in all medical specialties.

Conclusions: There is a statistically significant difference in service intensity between low and high earners in oral-maxillofacial surgery; however, the magnitude of the difference is unlikely to be clinically or economically meaningful. Variation in service intensity is lower in oral-maxillofacial surgery relative to all medical specialties in aggregate. Given the changing reimbursement landscape in medicine and surgery, it is important to evaluate existing billing practices within the specialty to advocate for the profession in discussions of payment reform and ensure that patients are receiving only necessary services.