Are We Working Harder for Less Pay? A Survey of Medicare Reimbursement for Hand and Upper Extremity Surgery

Abstract

Background: Ongoing concern for declining Medicare payment to surgeons may incentivize surgeons to perform more cases to maintain productivity goals. The authors evaluated trends in physician payment, patient charges, and reimbursement ratios for the most common hand and upper extremity surgical procedures. Methods: The authors examined Medicare surgeon payment, patient charges, and surgical volume from 2012 to 2017 for 83 common surgical procedures, incorporating the year-to-year Consumer Price Index to adjust for inflation. The reimbursement ratio was calculated by dividing payment by charge. Weighted (by surgery type and volume) averages were calculated. Results: Total Medicare surgeon payment increased 5.6 percent to $272 million for the studied procedures. Patient charges were seven times greater than payment, growing 24 percent to $1.9 billion. Despite growth of total payment, the average overall weighted payment for a single surgery decreased 3.5 percent. The average weighted patient charge increased 8 percent, whereas the reimbursement ratio decreased 13 percent. A hand surgeon would need to perform three more cases per 100 in 2017 to maintain the same reimbursement received in 2012. After categorizing these 83 surgical procedures, distal radius fixation (>3 parts, 21 percent increase; >2-part intra-articular, extra-articular, and percutaneous pinning, 17 percent increase), bony trauma proximal to the distal radius (10 percent increase), and upper extremity flap (5 percent increase) were subject to the greatest increases in payment. Payment for forearm fasciotomy (39 percent decrease), endoscopic carpal tunnel release (30 percent decrease), and mass excisions proximal to the wrist (18 percent decrease) decreased the most. Conclusions: From 2012 to 2017, despite a disproportionate increase in procedure charges, Medicare surgeon payment has not decreased substantially; however, total reimbursement is multifactorial and involves multiple sources of revenue and cost.

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

“… 7 A decrease in reimbursement despite increase in surgical volume is not unique to hip arthroscopy and has been observed with other orthopaedic procedures. 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%.…”

Trends in Open Versus Endoscopic Carpal Tunnel Release From 2010 to 2021

“…21,22 Importantly, rising reimbursement for CTR may not reflect a direct increase in payment to surgeons over the years. 22 Finally, this study identified several procedures commonly performed concomitantly with CTR-the most common being cubital tunnel release, trigger finger release, and intercarpal or CMC arthroplasty. Past studies have demonstrated that additional procedures are commonly performed on the same day as CTR when multiple pathologies are present.…”

Sometimes Less Is More!

“…Based on the results of this study, a surgical procedure for proximal humeral fractures in adolescence seems “too much.” However, the incentive to operate in many health-care environments may create a substantial surgeon preference toward treating fractures operatively. There have been a decrease in some reimbursement schedules for orthopaedic procedures 2 and a concern for surgeons being incentivized to perform more cases to maintain productivity goals 3 ; decreased reimbursement is a known stressor contributing to surgeon burnout.…”