Speaker: Reimbursement after TJA should be adjusted for high-risk Medicare patients
Click Here to Manage Email Alerts
GRAPEVINE, Texas — A speaker recommended risk-adjusted surgeon reimbursement after data showed mean reimbursement following total joint arthroplasty was lower for high-risk Medicare patients compared with their healthy counterparts.
“There has been minimal risk adjustment for the surgeon fee despite the fact that while literature shows that sicker patients may have longer OR times, worse outcomes and often more difficult surgery, the surgeons still are getting paid the same from the fee-for-service model,” Jack M. Haglin, MD, a second-year resident at the Mayo Clinic in Arizona, said in his presentation at the American Association of Hip and Knee Surgeons Annual Meeting.
Haglin and colleagues used 2019 Medicare Physician & Other Provider data to analyze surgeon reimbursement from 441,584 total hip and knee arthroplasty procedures for patients with varying levels of comorbidities.
Researchers used the hierarchal condition category (HCC) risk score to account for patient comorbidities, such as atrial fibrillation, Alzheimer's disease, congestive heart failure, chronic kidney disease, depression, diabetes, hypertension, ischemic heart disease, history of cancer and history of stroke. The higher-risk cohort was comprised of 50,004 patients with an HCC risk score of 1.5 or greater, while the lower-risk cohort was comprised of 391,580 patients with a score less than 1.5.
Across all procedures, mean surgeon reimbursement was $1,068.03. Haglin noted that despite the increased resources needed to care for patients in the higher-risk cohort, mean reimbursement was lower among these procedures ($1,059.21) compared with procedures involving lower-risk cohort ($1,073.32).
“This study may suggest that risk adjustment for surgeon reimbursement in TJA should be implemented in future payment models,” Haglin said.
“We need to remember that payment reform is most effective when it's physician led, and so I think we all can agree we have a big responsibility to inform ourselves and help lead the charge here,” he concluded.
Collapse
Haglin JM, et al. Paper 4. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 3-6, 2022; Grapevine, Texas.
Read more about
Click Here to Manage Email Alerts