Inflation-Adjusted Medicare Reimbursement Has Decreased for Orthopaedic Sports Medicine Procedures: Analysis From 2000 to 2020

Abstract

Background: Decreases in Medicare reimbursement have been noted among many medical specialties. An in-depth analysis of the subspecialty of orthopaedic sports medicine is needed to determine changes in Medicare reimbursement in this field. Purpose/Hypothesis: The purpose was to elucidate the trends in inflation-adjusted Medicare reimbursement for orthopaedic sports medicine procedures between 2000 and 2020. It was hypothesized that Medicare reimbursement decreased substantially during the study period. Study Design: Economic decision and analysis; Level of evidence, 4. Methods: The Physician Fee Schedule Look-up Tool was used to extract Medicare reimbursement information between 2000 and 2020 for 67 procedures related to orthopaedic sports medicine. These values were adjusted for inflation using the Consumer Price Index. The compound annual growth rate (CAGR) was calculated to measure the annual rate of change, and descriptive analyses were performed using the Student t test. Results: Between 2000 and 2020, inflation-adjusted Medicare reimbursement for the 67 included procedures decreased by an average of 33% (CAGR = –2.2%; R 2 = 0.78). Reimbursement decreased for procedures related to the shoulder and elbow by 34% (CAGR = –2.3%; R 2 = 0.80), for hip-related procedures by 23% (CAGR = –1.4%; R 2 = 0.77), for knee-related procedures by 31% (CAGR = –2.0%; R 2 = 0.81), and for procedures relating to the foot and ankle by 38% (CAGR = –2.5%; R 2 = 0.79). Conclusion: Study findings indicated that inflation-adjusted Medicare reimbursement decreased substantially between 2000 and 2020 for orthopaedic sports medicine procedures, ranging from a 23% decrease for hip-related procedures to a 38% decrease for foot and ankle–related procedures. The results of this study could be used to provide further context for health care policy decisions and help ensure sustainable financial environments for orthopaedic sports medicine surgeon.

Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy

“…This is slightly lower than the average reductions in reimbursement observed in orthopaedic sports medicine upper extremity and knee procedures with mean reductions of 31% and 34%, respectively. 18 However, these reductions for the upper extremity and knee sports medicine procedures were observed over a longer time frame from 2000 to 2020. Naturally, the overall reduction will be greater.…”

“…Our study found that the CAGR for hip arthroscopy procedures ranged from −1.74% to −2.18%, which is similar to the reported CAGR for shoulder/elbow (−2.3%) and knee procedures (−2.0%). 18 It is well-understood that hip arthroscopy typically has a longer surgical and setup time. Therefore, despite comparable yearly reductions in Medicare reimbursement, hip arthroscopic procedures may actually be experiencing a greater reduction in reimbursement by the hour.…”

Medicare Reimbursement Rates and Utilization Trends in Sacroiliac Joint Fusion

“…Multiple studies have examined the trends in Medicare reimbursement for physicians, with a nearly universal decline in inflation-adjusted compensation for various orthopaedic procedures. 11,18,23,[26][27][28][29][30][31][32] Regarding spine surgery, a recent study by Haglin et al 10 found that all 15 procedures they examined experienced a notable decrease in inflation-adjusted reimbursement, with an average of 33.8% from 2000 to 2021. When doing a subanalysis on temporal trends, the average adjusted reimbursement rate for all procedures decreased by 23.4% from 2000 to 2010 and 15.6% from 2010 to 2021 (P , 0.0001).…”

Regional Differences in Primary Total Knee Arthroplasty Utilization, Physician Reimbursement, and Patient Characteristics

“…An ongoing decline in Medicare physician reimbursement across most orthopaedic procedures has previously been identified [ [3] , [4] , [5] ]. Specifically, Haglin et al [ 3 ] found primary TKA surgeon reimbursement to decline by 41.9% when adjusting for inflation between 2000 and 2019.…”