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Patient Perceptions on Physician Reimbursement in Plastic Surgery
Ryan M. Garcia, M.D.1, Ezequiel Cassinelli, M.D.1, C. Scott Hultman, MD, MBA, FACS2, Detlev Erdmann, MD, PhD, MHSc1.
1Duke University Medical Center, Durham, NC, USA, 2University of North Carolina, Chapel Hill, NC, USA.

PURPOSE: Public perception on physician reimbursement may be that considerable payments are received after performed procedures, particularly in plastic surgery. This perception may be in direct contrast to the actual decline in compensation from insurance companies. The purpose of this study is to investigate patient perceptions on physician reimbursement following common plastic surgery procedures.
METHODS: An IRB exempt survey was administered to 140 patients. The survey consisted of 4 common, single-staged plastic surgery procedures which were detailed and illustrated. Patients were asked for their opinion on current insurance company reimbursements to the surgeon for each procedure (excluding hospital and anesthesia charges) and what they believed the reimbursement fee should be.
RESULTS: Eighty-four patients (45 female, 39 male; average age 50) completed the survey (60% response). The majority of patients (79%) reported to carefully review their medical bills. Patients thought physicians were reimbursed 472% to 1061% more than the actual fee for breast reduction, 347% to 770% more for abdominal hernia reconstruction, 372% to 787% more for panniculectomy, and 290% to 628% more for mandibular fracture open reduction and internal fixation (Table 1). Despite these perceived higher than actual fee payments, 87% of patients thought that plastic surgeons should have overall higher reimbursements from their insurance company and 97% thought plastic surgeons should have higher reimbursements for more difficult cases. No statistical differences were noted between patient’s perceived physician reimbursement responses and the different insurance carriers, highest education levels, or income levels reported.
CONCLUSION: Patients surveyed in this study overestimated plastic surgery procedure fees from insurance companies by 290% to 1061%. Despite this overestimation, 87% of patients believed that physicians should have even higher reimbursements. In an era of declining physician reimbursements but increasing overhead costs; we believe it is important to inform and educate patients regarding current fee schedules to plastic surgeons in order to correct current misconceptions.
Perceived and suggested patient reimbursements to plastic surgeons
Average Perceived Physician ReimbursementPercentage of Private Insurance FeePercentage of Medicare FeePercentage of Medicaid FeeAverage Suggested Physician Reimbursement
Breast Reduction$9,067.12472%923%1061%$9,571.42
Abdominal Hernia Reconstruction$11,637.80 347%656%770%$12,300.00
Panniculectomy$6.901.35372%678%787%$7,471.83
Mandible Fracture Repair$5,615.75 290%531%628%$6,132.14


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