Medicare reimbursement for orthopedic trauma surgery has ‘steadily decreased’ since 2000
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The average Medicare reimbursement for orthopedic trauma procedures has decreased by 30% since 2000, according to recently published results.
Foot and ankle procedures had the greatest decrease in mean adjusted reimbursement, while shoulder and upper extremity procedures had the smallest decrease.
Researchers from the Mayo Clinic Alix School of Medicine and NYU Langone Health used the CMS physician fee schedule look-up tool to assess physician reimbursement on the 20 most commonly billed orthopedic trauma CPT codes. For all procedures, researchers calculated average annual and total percentage change in reimbursement, according to the study.
After adjusting for inflation to 2020 U.S. dollars, researchers found average Medicare reimbursement for all orthopedic trauma procedures decreased by 30% from 2000 to 2020.
According to the study, foot and ankle procedures decreased in mean adjusted reimbursement by 42.6%. Hip fracture procedures decreased by 31.9%. Lower extremity long bone procedures decreased by 30.9%. Shoulder and upper extremity procedures decreased by 23.7%. Researchers also noted that the adjusted reimbursement rate for all procedures decreased by an average of 1.5% per year.
“The implications of these generalized findings are widespread. First, with the aging population in the United States, government-funded health insurance programs represent an increasing portion of annual health care expenditure. Further, it is well documented that the policies of the CMS regarding reimbursement rates and coverage influence private insurers and private reimbursement rates for procedures,” the researchers wrote in the study. “Thus, the decisions made by the CMS have a large-scale impact on reimbursement, influencing both the public and private health care sectors,” they added.
“Increased awareness and consideration of these trends will be important moving forward for surgeons, policymakers and hospital committees as progress is made to develop agreeable reimbursement models that allow for the sustained growth and continued access to quality orthopedic trauma care in the United States,” the authors concluded.
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