There was a steady decrease in reimbursement for procedures in all orthopedic subspecialties except for removal of an orthopedic implant. Adult reconstruction had the greatest rate of decrease, according to results published in Orthopedics.
Reimbursement Down for Most Orthopedic Subspecialties
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“Alan H. Daniels, M.D., and his colleagues examined the Medicare Physician Fee Schedule for the most common orthopedic and non-orthopedic procedures performed between 2000 and 2016 and adjusted prices for inflation to 2016-dollar values.”
They then calculated compound annual growth rates to assess mean growth rates for each procedure and subspecialty, and calculated year-to-year dollar amount changes for each procedure and subspecialty. They also compared reimbursement trends for individual procedures and across subspecialties.
“Results showed that, except for removal of an orthopedic implant, all orthopedic procedures had a decrease in reimbursement between 2000 and 2016. Researchers found shoulder arthroscopy/decompression, total knee replacement, total hip replacement, repair of tendons/rotator cuff and repair of high/trochanteric fracture had the greatest annual decreases in reimbursement.”
Procedures that had the least annual decreases in reimbursement, according to the report, were removal of orthopedic implant, debridement of skin/muscle/bone/fracture, repair fracture of radius/ulna/percutaneous, carpal tunnel release and repair of ankle fractures.
“Rate of Medicare procedure reimbursement change varied between subspecialties,” Daniels told Healio.com/Orthopedics. “Trauma procedures had the smallest decrease in annual change compared with spine, sports and hand.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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