Can a Hip and Knee Adult Reconstruction Orthopaedic Surgeon Sustain a Practice Comprised Entirely of Medicare Patients?

Zuckerman, Joseph D.; Koli, Emmanuel; Inneh, Ifeoma A.; Iorio, Richard

doi:10.1016/j.arth.2014.02.041

Cited by 13 publications

(5 citation statements)

References 5 publications

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“…25,26 A hypothetical Medicare-only practice model for orthopedic surgeons specializing in total joint arthroplasty was not found to be sustainable based on current Medicare reimbursement rates. 27 While a Medicare-only reimbursement model is not realistic, a physician practice model, and ultimately the physician salary, with a large percentage of Medicare beneficiaries may become less sustainable.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019

Thornburg

Gupta

Chow

et al. 2021

Hand (New York, N,Y.)

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Background: Medicare reimbursement trends across multiple surgical subspecialties have been analyzed; however, little has been reported regarding the long-term trends in reimbursement of hand surgery procedures. The aim of this study is to analyze trends in Medicare reimbursement for commonly performed hand surgeries. Methods: Using the Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File, we determined the 20 hand surgery procedure codes most commonly billed to Medicare in 2016. Reimbursement rates were collected and analyzed for each code from The Physician Fee Schedule Look-Up Tool for years 2000 to 2019. We compared the change in reimbursement rate for each procedure to the rate of inflation in US dollars, using the Consumer Price Index (CPI) over the same time period. Results: The reimbursement rate for each procedure increased on average by 13.9% during the study period while the United States CPI increased significantly more by 46.7% ( P < .0001). When all reimbursement data were adjusted for inflation to 2019 dollars, the average reimbursement for all included procedures in this study decreased by 22.6% from 2000 to 2019. The average adjusted reimbursement rate for all procedures decreased by 21.92% from 2000 to 2009 and decreased by 0.86% on average from 2009 to 2019 ( P < .0001). Conclusion: When adjusted for inflation, Medicare reimbursement for hand surgery has steadily decreased over the past 20 years. It will be important to consider the implications of these trends when evaluating healthcare policies and the impact this has on access to hand surgery.

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Section: Discussionmentioning

confidence: 99%

An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019

Thornburg

Gupta

Chow

et al. 2021

Hand (New York, N,Y.)

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“…The decline provider reimbursement and the impact on the availability of care has been highlighted in plastic surgery and in other surgical specialties and few solutions have been offered. 12,15,21 One alternative strategy may be the development of a limited number of centers for excellence for these procedures, which would lead to improved negotiating power with payors and greater operating efficiency. However, for many patients, travel to these institutions would prove to be a limiting factor in receiving care, and the disparity of access would continue or worsen.…”

Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Study of Variations in Reimbursement for Breast Reconstruction

Odom

Schmidt

Myckatyn

et al. 2018

Annals of Plastic Surgery

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“…Prior studies have suggested that variations in treatment based on payer type may relate in part to lower physician reimbursement rates from Medicare. 22 The effect of payments on care is obviously complex and may be more nuanced than the dollar amount reimbursed. For example, there is evidence that reduced payment delays for Medicare-related services increase physician treatment of Medicare patients.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Utilization of Steroid Injections in the Treatment of Lumbosacral Degenerative Conditions in the United States

2018

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Background: Lumbar degenerative conditions are an extremely common set of diagnoses with a large spectrum of treatment options. Epidural steroid injections (ESI) are widely used but have come under increased scrutiny as we move toward a value-based model of health care. We assessed current utilization of epidural steroid injections, changes in utilization over time, and the influence of payer type and geographic region within the United States on their utilization. In addition, we analyzed the relationship between ESIs and surgical rates across states. Methods: The Medicare 5% national sample administrative database (SAF5) and a large national database from a commercial health care company (HORTHO) were used to catalog clinical data for patients with lumbar degenerative conditions. Specific queries into the rate of ESIs and lumbar surgery were also performed within this group. Results: There were 4 108 121 patients found between 2005 and 2015 in the SAF5 and HORTHO databases carrying a diagnosis related to lumbar degenerative conditions. The overall yearly injection rates for patients with lumbar degenerative conditions ranged from 9.84% to 10.18%. In patients older than 65, the rate of ESI was higher for Medicare as compared with private payer insurance (16.27% versus 14.14%, P , .001). There was a higher rate of ESI for patients who eventually underwent surgery in the Medicare group as compared with the commercial group (55.30% versus 40.40%, P , .001). There was a positive correlation between rates of ESI with the rate of surgery between states. Conclusions: There is considerable variation in treatment of lumbar degenerative conditions with ESI based on payer type. There was increased utilization of lumbar ESI between 2007 and 2012, although this change was less than 0.5%. The data also suggest a positive correlation between rates of ESIs and surgical intervention across states. This points to areas in the country with high utilization of both ESI and surgery in the treatment of lumbar degenerative conditions.

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Can a Hip and Knee Adult Reconstruction Orthopaedic Surgeon Sustain a Practice Comprised Entirely of Medicare Patients?

Cited by 13 publications

References 5 publications

An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019

An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019

A Cross-Sectional Study of Variations in Reimbursement for Breast Reconstruction

Factors Affecting Utilization of Steroid Injections in the Treatment of Lumbosacral Degenerative Conditions in the United States

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