Surgeons received greater reimbursement for arthroscopy procedures in healthier patients
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Key takeaways:
- Mean BMI was greater in patients who were sicker. A greater percentage of them had all comorbidities.
- Mean reimbursement rate for rotator cuff repair and meniscal debridement was greater with healthy patients.
NEW ORLEANS — Results presented at the Arthroscopy Association of North America Annual Meeting showed that surgeon reimbursement for basic arthroscopy procedures was greater with healthier patients.
Using the 2020 Medicare Physician and Other Practitioner database, Jack M. Haglin, MD, and colleagues identified more than 24,000 patients who underwent either arthroscopic rotator cuff repair or meniscal debridement.
“We also took the mean hierarchical condition category, or HCC, risk score, which is in the database for all patients,” Haglin said. “Essentially, it’s a standardized scoring system based on comorbidities evaluating patient risk with 1.0 being your standard-risk patient.”
Researchers categorized episodes of care into two groups based on whether there was a mean HCC under 1.5 or of 1.5 or greater and compared all variables across cohorts.
“When we looked at the sicker cohort, unsurprisingly, these patients had a higher percentage of all the comorbidities included in the database,” Haglin said. “They also had a higher mean BMI compared to the healthier, less complex patients.”
However, Haglin noted a greater mean reimbursement rate for both procedures with patients in the healthy cohort compared with patients in the sicker cohort, about $15.50 more for rotator cuff repair and about $13.50 more for meniscal debridement, on average, per procedure.
“[These results] beg the question moving forward: How do we quantify and reimburse for the additional resources and time that might be required to care for sicker or more complex patients and how do we properly incentivize their care?” Haglin said.
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Haglin JM, et al. Should surgeon Medicare reimbursement for arthroscopy be risk adjusted for patient complexity? Presented at: Arthroscopy Association of North America Annual Meeting; May 4-6, 2023; New Orleans.
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