feat: skin sub budget neutrality notebook #291

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kert merged 2 commits from feat/skin-sub-budget-neutrality into main 2026-03-27 03:24:19 +00:00

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kert commented 2026-03-27 02:41:03 +00:00

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Summary

• New marimo notebook analysing how skin substitute application code (15271-15278) RVU growth redistributes payment away from other PFS services under budget neutrality
• 8 sections: RVU pool share, PE revaluation trajectory, implied tax rate, service category burden, CF erosion, per-code dollar impact, cumulative tax, key findings
• Uses unweighted RVUs as structural proxy (utilization data would amplify the effect)

Key findings

• PE RVUs grew 34% (16.45→22.05) while Work stayed flat at 13.46
• Per-code compression is fractions of a cent (structural), but volume amplifies
• Resp/Cardiovascular and Musculoskeletal bear the largest absolute burden
• CY2026 reclassification doesn't directly affect PFS pool but changes volume incentives

refs #246

## Summary - New marimo notebook analysing how skin substitute application code (15271-15278) RVU growth redistributes payment away from other PFS services under budget neutrality - 8 sections: RVU pool share, PE revaluation trajectory, implied tax rate, service category burden, CF erosion, per-code dollar impact, cumulative tax, key findings - Uses unweighted RVUs as structural proxy (utilization data would amplify the effect) ## Key findings - PE RVUs grew 34% (16.45→22.05) while Work stayed flat at 13.46 - Per-code compression is fractions of a cent (structural), but volume amplifies - Resp/Cardiovascular and Musculoskeletal bear the largest absolute burden - CY2026 reclassification doesn't directly affect PFS pool but changes volume incentives refs #246

kert added 1 commit 2026-03-27 02:41:03 +00:00

feat: skin sub budget neutrality notebook — PFS cross-service impact ... 0d6e191fa4

Analyses how skin substitute application code (15271-15278) RVU growth
redistributes payment away from other services under PFS budget
neutrality.

8 sections:
1. Skin sub share of unweighted RVU pool over time
2. PE RVU revaluation trajectory (PE grew 34% while Work stayed flat)
3. Implied budget neutrality tax rate per year
4. Service category burden (which specialties absorb the compression)
5. Conversion factor erosion vs RVU pool growth
6. Per-code dollar impact on common services (99213, 27447, etc.)
7. Cumulative PE RVU structural tax since 2015
8. Key findings (volume amplifier, PE battleground, CY2026 shift)

refs #246

kert added 1 commit 2026-03-27 02:56:51 +00:00

feat: beneficiary cost sharing notebook — coinsurance trends and CY2026 impact ... 47a18ee458

Tracks skin substitute beneficiary out-of-pocket costs over time:

1. Application fee coinsurance by region (20% of PFS carrier fee)
2. Product coinsurance trajectory (20% of ASP+6% per cm²)
3. Total episode cost sharing for 25cm² wound (product + application)
4. OPPS copayment collapse: $105-366 (2021-2025) → $25.43 flat (2026)
5. Winners/losers: high-ASP products save, low-ASP products pay more
6. Episode scenarios: Apligraf, EpiFix, GrafixCore before/after CY2026
7. Part B deductible context ($147 in 2015 → $257 in 2025-2026)
8. Key takeaways

refs #246

kert merged commit 01e44faf91 into main 2026-03-27 03:24:19 +00:00

kert referenced this issue from a commit 2026-03-27 03:24:19 +00:00

Merge pull request 'feat: skin sub budget neutrality notebook' (#291) from feat/skin-sub-budget-neutrality into main

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Reference: homelab/stack#291