Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

Abstract

Background: Charge and reimbursement trends for arthroscopic partial meniscectomies among orthopaedic surgeons, anesthesiologists, and hospital/surgery centers have not been formally analyzed, even though meniscectomies are the most commonly performed orthopaedic surgery. Purpose: To analyze Medicare charge and reimbursement trends for surgeons, anesthesiologists, and hospital/surgery centers for outpatient arthroscopic partial meniscectomies performed in the United States. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: We analyzed trends in surgeon, anesthesiologist, and hospital charges and reimbursements for outpatient isolated arthroscopic partial meniscectomies from 2005 to 2014. Current Procedural Terminology codes were used to capture charge and reimbursement information using the nationally representative 5% Medicare sample. National and regional trends for charge, reimbursement, and Charlson Comorbidity Index (CCI) were evaluated using linear regression analysis. Results: A total of 31,717 patients were analyzed in this study. Charges across all groups increased significantly ( P < .001) during the 10-year study period, with an increase of 18.4% ($2754-$3262) for surgeons, 85.5% ($802-$1480) for anesthesiologists, and 116.8% ($2743-$5947) for hospitals. Surgeon reimbursements declined by 15.5% ($504-$426; P = .072) during this period. Anesthesiologist and hospital reimbursements increased significantly during by 36.5% ($133-$182; P < .001) and 28.9% ($1540-$1984; P < .001) during the 10-year study period, respectively. The annual incidence of partial meniscectomies per 10,000 database patients decreased significantly from 18.3 to 15.6 over the course of the study (14.8% decrease; P = .009), while the CCI did not change significantly ( P = .798). Conclusion: Hospital and anesthesiologist Medicare reimbursements for outpatient arthroscopic partial meniscectomies increased significantly, while surgeon reimbursements decreased. In 2005, hospitals were reimbursed 205% more ($1540 vs $504) than surgeons, and by 2014, they were reimbursed 365% more ($1984 vs $426), indicating that the gap between hospital and surgeon reimbursement is rising. Improved understanding of charge and reimbursement trends represents an opportunity for key stakeholders to improve financial alignment across the field of orthopaedics.

Ambulatory Surgery Centers Significantly Decrease Total Health Care Expenditures in Primary Anterior Cruciate Ligament Reconstruction

“…Numerous investigations demonstrated that real surgeon reimbursement has been declining over time. 6,9,10,14,18,22,27,35 LaPrade et al 14 found that surgeon reimbursement for outpatient arthroscopic meniscectomy decreased 15.5% from 2005 to 2014, while the current study demonstrated a 1.2% decline per year in surgeon reimbursement. Taken together, these findings suggest that cost-optimization strategies may be more efficacious when they are not provider-focused.…”

Inflation-Adjusted Medicare Reimbursement for Hip Arthroscopy Fell by 21.1% on Average Between 2011 and 2022

“… 26 , 27 For arthroscopic partial meniscectomy, LaPrade et al. 28 found that from 2005 to 2014, increasing hospital reimbursement outpaced declining surgeon reimbursement by 365%. They hypothesized drivers of this gap included material overhead, hospital administration, and devaluation of the CPT analyzed in the study.…”

Optimizing Health Care Policy by Rewarding Innovation and Improved Outcomes

“…The policy of paying hospitals substantially more, in some cases twice as much, for the identical services provided in an outpatient setting acts as a disincentive to pursuing innovations that shift care out of the higher-cost hospital setting, thus perpetuating inflationary cost trends and inhibiting patient access 8. These payment differentials poorly use taxpayer and beneficiary dollars while providing mega-hospital systems with the ability to acquire physician practices and promote consolidation, thereby limiting market competition and restricting treatment options for patients 9–13. As shown in Figure 1, the cost of inpatient procedures varies 3-fold across several local hospital partners within our institution, with no difference in clinical outcomes.…”

“…taxpayer and beneficiary dollars while providing mega-hospital systems with the ability to acquire physician practices and promote consolidation, thereby limiting market competition and restricting treatment options for patients. [9][10][11][12][13] As shown in Figure 1, the cost of inpatient procedures varies 3-fold across several local hospital partners within our institution, with no difference in clinical outcomes.…”