LAUSR

There has been a slow but steady rise in Australia over the past 20 years in the proportion of groin hernias repaired using a minimally invasive surgery (MIS) approach. In 2011/12, the absolute number of MIS operations performed for inguinal and femoral hernias overtook the number of open operations. The reasons for this are multifactorial and not necessarily based on strong clinical evidence or economics. When considering fixed costs such as operating room time and the use of disposables, in 2011/12 laparoscopic inguinal hernia repair in a Victorian metropolitan public hospital was AUS$1268 extra per procedure than open repair. In a private hospital in NSW in 2016, laparoscopic hernia repair performed as an overnight stay was AUD$2000 extra per procedure than an open repair done as a short stay operation. In the United States, the number of robotic-assisted inguinal hernia repairs rose an average of 2% per year from 2012 to 2018 across 73 Michigan hospitals, and cost an additional AUS $3260 (US$2200) per procedure compared with laparoscopic repair. The rising trends in MIS for groin hernia repair and increased access to robotics in Australia suggest that healthcare costs in relation to this surgical condition are set to increase. However, the potential impact of changing surgeon preferences on Medicare Benefits Schedule (MBS) expenditure for groin hernia repairs is unknown. In July 2021, Medicare introduced changes to the classification of abdominal wall hernias including a new MBS item number (30748) to replace the two previous numbers for laparoscopic or open repairs (30 609 or 30 614, respectively); raising the MBS fee slightly from $479.05 to $483.35 regardless of technique. This change effectively removed classifications for the surgeon’s chosen repair method. The rationale behind this decision is unclear but has the potential to increase hospital and patient out of pocket costs if the repair method involves the use of significant disposable equipment or is followed by complications. The current report analysed Medicare statistical data for groin hernia repair procedures from July 2000 to June 2021—prior to the introduction of the new MBS item number. These data describe the Medicare reimbursement for hernia repair during this period, although this does not necessarily represent the cost of the operation or what the hospitals or surgeons charge.