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Medicare reimbursement for orthopedic procedures decreases from 2000 to 2016
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NEW ORLEANS — Reimbursement for orthopedic procedures has decreased from 2000 to 2016, with adult reconstruction reimbursement decreasing at a greater rate than other subspecialties, according to data presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
“Understanding trends in reimbursement is absolutely critical to the financial sustainability of orthopedic practices. Whether we want to admit it or not, our reimbursement is imperative in that orthopedics is a business whether you are in private practice or academics,” Alan H. Daniels, MD, said here.
Daniels and colleagues evaluated Medicare reimbursement trends for the most common orthopedic surgical procedures using Medicare physician reimbursement rates for common orthopedic and non-orthopedic procedures for comparison. They examined the Medicare Physician Fee Schedule and CPT codes for the procedures performed between 2000 and 2016. They adjusted reimbursement rates to 2016-dollar values. They calculated compound annual growth rates and mean growth rates for the procedures and subspecialties. In addition, they calculated year-to-year dollar amount changes for each procedure and subspecialty.
Annual reimbursements decreased for all the orthopedic procedures, Daniels said, except for the removal of support implants, which showed a gain of $0.46. He said the procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression (-$58.79), total knee replacement (-$47.51), total hip replacement (-$40.92), repair of tendons/rotator cuff (-$39.57), and repair of trochanteric femur fracture (-$34.91). The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release (-$6.12) and ankle fracture repair (-$9.42).
Daniels and colleagues found the rate of Medicare procedure reimbursement change varied among subspecialties. Orthopedic trauma had the smallest decrease in annual change (-$11.72), and spine surgery, sports medicine and hand surgery showed the largest decreases in annual change at -$21.72, -$26.61 and -$28.62, respectively. Annual reimbursement for adult reconstruction procedures significantly decreased faster and by greater amounts than other subspecialties, with the least rapid decrease seen in trauma, he said. – by Kristine Houck, MA, ELS
Reference:
Eltorai AE, et al. Paper #217. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 6-10, 2018; New Orleans.
Disclosure: Daniels reports he is a paid consultant for DePuy Synthes, Globus Medical, Orthofix, SpineArt and Stryker; receives research support from Orthofix; and receives publishing royalties, financial or material support from Springer.
Perspective
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John J. Crawford, MD
Three groups of people should pay careful attention to this data: practice leaders whose job it is to make long-term plans regarding investment in facilities, physician recruitment and physician pay schedules; orthopedic residents who choose the fellowship that they will apply for and who recognize that reimbursement is important; and mid- to late-life cycle surgeons who either want to validate the pain that they have felt or see if their specialty is next on Medicare's chopping block.
Anyone paying attention to their reimbursements during the past decade or so has felt this pain personally, but this paper applies some appreciated quantification and validation to what surgeons have experienced.
The major limitation of the study is it does not consider local variations due to Medicare's regional adjustments, but from a national perspective. This data is important to know from an advocacy standpoint. It will be interesting to see if the abundant data presented during the past 5 years quantifying the significant societal value generated by many orthopedic procedures will reverse or arrest these trends.
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