State Variation in Medicaid Reimbursements for Orthopaedic Surgery

Lalezari, Ramin M.; Pozen, Alexis; Dy, Christopher J.

doi:10.2106/jbjs.17.00279

Cited by 16 publications

(4 citation statements)

References 16 publications

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“…Prior studies described similar variability that exists among general orthopedics and its subspecialties. Lalezari et al 9 studied the 10 most commonly performed inpatient orthopedic procedures and found a great magnitude of variation between MCD and MCR reimbursement with coefficients of variations ranging from 0.32 in hip hemiarthroplasty to 0.57 in posterolateral lumbar interbody arthrodesis. Of note, the range of variability of MCD reimbursement was greater than $1500 for all procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Using the methodology of Lalezari et al, 9 the Medicare Wage Index was calculated to adjust for cost of living in different states to create an MCR Wage Index-Adjusted MCD reimbursement. The range of variation in MCD reimbursement and MCR Wage Index-adjusted MCD reimbursement was described, as well as the coefficient of variation (standard deviation divided by mean).…”

Section: Methodsmentioning

confidence: 99%

“…8 Previous studies described the variation in MCD and MCR reimbursement as a driving force for suboptimal access to necessary orthopedic care, a longer time from diagnosis to surgery, and a potential obstacle as policy shifts toward focusing reimbursement on value. [8][9][10][11] A 2018 investigation describes the variation in MCR payments across states but does not mention MCD payments. 12 A patient's government insurance type should not dictate the quality or quantity of care options they have access to.…”

Section: Introductionmentioning

confidence: 99%

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Variability in Medicaid Reimbursement in Hand Surgery May Lead to Inequality in Access to Patient Care

Baker

Rivlin

Sodha

et al. 2020

Hand (New York, N,Y.)

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Background: Medicare (MCR) and Medicaid (MCD) remain the dominant providers of government-funded health insurance in the United States. The purpose of this study was to evaluate the variability between MCR and MCD reimbursements for common hand and wrist surgical procedures. We hypothesized that MCD reimbursement rates would have substantial variation between states, whereas MCR rates would remain relatively constant. Methods: Using the Medicare Physician Fee Schedule Database, the 2019 reimbursements for 7 common hand and wrist procedures were recorded via the respective Current Procedural Terminology codes. The MCD reimbursement rates were then obtained from each state’s physician fee schedule database. Comparisons of reimbursement for these procedures were then calculated between states and between MCD and MCR while adjusting for cost of living using the Medicare Wage Index. Finally, the coefficients of variation were computed to compare the extent of variability between the insurance types. Results: Across all procedures, reimbursement rates for MCD ranged from 30.6% to 240% of the average MCR reimbursement, with the mean reimbursement for MCD valued at 78.3% of MCR. Endoscopic carpal tunnel release (CTR) is valued similarly by MCD compared with open CTR with an average of 77.7% and 78.2% reimbursement of MCR, respectively. The coefficients of variation for MCD reimbursements ranged from 0.25 to 0.45, whereas the value was 0.06 for all MCR procedures. Conclusions: These findings demonstrate a wide variation in MCD payments between states. When compared with MCR, the lower average state MCD reimbursement questions the sustainability for hand surgeons to accept these patients in practice.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variability in Medicaid Reimbursement in Hand Surgery May Lead to Inequality in Access to Patient Care

Baker

Rivlin

Sodha

et al. 2020

Hand (New York, N,Y.)

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“…For each category of admissions (all cases, elective, and trauma), the number of admissions in the category was used as the weighting variable. Forms of the coefficient of variation have been used in prior orthopaedic health services work to quantify variation [13][14][15][16][17] , with values of >60 being considered very high variation 16,17 .…”

Section: Methodsmentioning

confidence: 99%

Variation in the Delivery of Inpatient Orthopaedic Care to Medicaid Beneficiaries within a Single Metropolitan Region

Tipping

Nickel

et al. 2019

The Journal of Bone and Joint Surgery

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Background: There is variability in access to and utilization of orthopaedic care, particularly for those with Medicaid insurance. One potential contributor is perceived unwillingness of surgeons and hospitals to accept underinsured patients. We used administrative data to examine the payer mix for select inpatient orthopaedic surgical procedures at all hospitals within a single region, hypothesizing that the delivery of orthopaedic surgery to Medicaid beneficiaries varies highly at the hospital level.Methods: Using administrative data, we analyzed inpatient hospitalizations for elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial and fibular fracture repair) among 22 hospitals in a single region from 2011 to 2016 for patients who were 18 to 64 years of age. The primary outcome was the percentage of each hospital's caseload with Medicaid listed as the primary payer. The secondary outcome measured each hospital's Medicaid percentage against the percentage of Medicaid-insured individuals within 10 miles of the hospital (Medicaid share ratio), using a ratio of 1 as a benchmark. To quantify variation, we calculated a weighted coefficient of variation of the Medicaid share ratio for all cases combined, elective cases only, and trauma cases only.Results: For all cases (n = 19,204), the mean percentage of Medicaid-funded surgical procedures was 7.6% (range, 0.2% to 57.3%). The mean Medicaid share ratio was 1.0 (range, 0.05 to 4.20). Across 22 hospitals, the weighted coefficient of variation for Medicaid share was 69, indicating very high variation. For elective cases alone, the mean percentage of Medicaid-funded surgical procedures was 5.5% (range, 0.2% to 64.6%). The mean Medicaid share ratio was 0.71 (range, 0.05 to 4.73), and the weighted coefficient of variation was 93. For trauma cases alone, Medicaid-funded surgical procedures were 14.7% (range, 0.0% to 35.7%). The mean Medicaid share ratio was 2.0 (range, 0 to 3.93), and the weighted coefficient of variation was 34.Conclusions: Delivery of care was highly variable when benchmarking against the insurance composition of each hospital's surrounding community. Although generalizability to other regions is limited, our findings support previously asserted notions that delivery of orthopaedic care may differ on the basis of socioeconomic markers (such as insurance status). If not addressed, these inequities may exacerbate existing racially and socioeconomically based disparities in care.

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What Factors Affect Whether Patients Return to the Same Surgeon to Replace the Contralateral Joint? A Study of Over 200,000 Patients

Moore

Schneble

Kahan

et al. 2022

The Journal of Arthroplasty

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State Variation in Medicaid Reimbursements for Orthopaedic Surgery

Abstract: Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

Cited by 16 publications

References 16 publications

Variability in Medicaid Reimbursement in Hand Surgery May Lead to Inequality in Access to Patient Care

Variability in Medicaid Reimbursement in Hand Surgery May Lead to Inequality in Access to Patient Care

Variation in the Delivery of Inpatient Orthopaedic Care to Medicaid Beneficiaries within a Single Metropolitan Region

What Factors Affect Whether Patients Return to the Same Surgeon to Replace the Contralateral Joint? A Study of Over 200,000 Patients

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