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August 18, 2020; 95 (7) Article

The effects of the Medicare NCS reimbursement policy

Utilization, payments, and patient access

View ORCID ProfileEvan L. Reynolds, Kevin A. Kerber, Chloe Hill, Lindsey B. De Lott, Brandon Magliocco, Gregory J. Esper, View ORCID ProfileBrian C. Callaghan
First published July 17, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010090
Evan L. Reynolds
From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
PhD
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  • ORCID record for Evan L. Reynolds
Kevin A. Kerber
From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
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Chloe Hill
From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
MD, MS
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Lindsey B. De Lott
From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
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Brandon Magliocco
From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
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Gregory J. Esper
From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
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Brian C. Callaghan
From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
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The effects of the Medicare NCS reimbursement policy
Utilization, payments, and patient access
Evan L. Reynolds, Kevin A. Kerber, Chloe Hill, Lindsey B. De Lott, Brandon Magliocco, Gregory J. Esper, Brian C. Callaghan
Neurology Aug 2020, 95 (7) e930-e935; DOI: 10.1212/WNL.0000000000010090

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Abstract

Objective To determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare use, payments, and patient access to Medicare physicians by performing a retrospective analysis of Medicare data (2012–2016 fee-for-service data from the CMS Physician and Other Supplier Public Use File).

Methods Individual billable services were identified by Healthcare Common Procedure Coding System Current Procedural Terminology and G codes. Medicare use and payments were stratified by specialty and type of service (electrodiagnostic tests, including NCS and EMG, and other neurologic procedures). We also assessed access to Medicare physicians using the annual number of unique beneficiaries receiving initial Evaluation and Management (E/M) services.

Results We identified 676,113 Medicare providers included in all analysis years from 2012 to 2016 (10,599 neurologists, 5,881 physiatrists, and 659,633 other specialties). Comparing 2016 to 2012 showed that 21.1% fewer neurologists, 28.6% fewer physiatrists, and 69.3% fewer other specialists performed NCS and 3.8% fewer neurologists, 21.7% fewer physiatrists, and 5.6% fewer other specialists performed EMG. For NCS providers in 2012, the mean number of unique Medicare beneficiaries increased for neurologists (1.2%) and physiatrists (4.8%) but decreased for other specialists (−6.5%) by 2016. After the NCS cut, the number of providers performing autonomic and evoked potential testing increased substantially.

Conclusions The Medicare NCS reimbursement policy resulted in a larger decrease in NCS providers than in EMG providers. Despite fewer neurologists and physiatrists performing NCS, Medicare access to these physicians for E/M services was not affected. Increased autonomic and evoked potential testing may be an unintended consequence of NCS reimbursement change.

Glossary

E/M=
Evaluation and Management;
NCS=
nerve conduction studies

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 283

  • Received December 12, 2019.
  • Accepted in final form March 2, 2020.
  • © 2020 American Academy of Neurology
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