Reimbursement, utilization of orthopedic surgery gradually declined in CMS population
Key takeaways:
- There was a gradual decline in reimbursement for all clinical services from 2016 to 2024.
- Procedural services among the CMS population also declined from 2016 to 2024.
SAN DIEGO — Reimbursement and utilization rates have gradually declined for orthopedic surgeries in the CMS population, according to results presented here.
“At this trend rate, it is unsustainable for patient care,” Adam S. Levin, MD, FAAOS, associate professor of orthopedic surgery at Johns Hopkins Hospital, told Healio.
Using the CMS Physician Fee Schedule Look-Up Tool, Levin and colleagues analyzed publicly available reimbursement data from 2016 to 2024, which was adjusted for inflationary rates and compared with outpatient/office evaluation and management services. They also evaluated the association of reimbursement with procedural utilization rates.
Levin said there was a gradual decline in reimbursement for all clinical services, despite evaluation and management services rates remaining relatively flat.
In addition, he said the procedural services among the CMS population also declined, even after adjusting for the impact of COVID-19 on utilization.
“Without a fix from both increased funding for clinical care services and from CMS regarding bundled services within the surgical global period, this is not a sustainable formula for appropriate care of the CMS population,” Levin said.
He added, “In order to understand what the value of the care is that we provide, that necessitates a real understanding of what costs and reimbursements are. Given the opacity of how that information makes it to us, it makes it challenging to understand what true value-based care arrangements should look like.”
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Levin AS, et al. Paper 84. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.