Declining Trends in Medicare Reimbursement in Orthopaedic Foot and Ankle Surgery

Abstract

Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma; Other Introduction/Purpose: With the increasing complexity of physician reimbursement models, understanding reimbursement trends is crucial to the financial sustainability of orthopaedic practices nationwide. Inflation-adjusted Medicare physician reimbursement for total joint arthroplasty has decreased by approximately 33% from 2000 to 2019. Recent trends in orthopaedic foot and ankle reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2020 for common orthopaedic foot and ankle surgical procedures. Methods: The financial database of a single academic tertiary care center was queried to identify the CPT codes most frequently utilized in orthopaedic foot and ankle care. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the consumer price index and reported in 2020 US dollars (USD). Average annual and the total percent change in reimbursement were calculated for included procedures. Results: After adjusting for inflation, the average physician reimbursement decreased by 31.6% for all included foot and ankle procedures from 2000 to 2020, with 23/30 codes decreasing by more than 30%. The greatest decrease in reimbursement observed from 2000 to 2020 was for open treatment of calcaneal fracture at 48.3% ($2,254.17 to $1,164.97), followed by flexor tendon repair at 48.2% ($741.02 to $357.39), and open treatment of pilon fracture at 43.9% ($2,451.37 to $1,076.36). Conclusion: Over the past two decades, physician reimbursement for foot and ankle procedures has dramatically decreased by up to 48.3%. Continued downward trends in orthopaedic foot and ankle physician reimbursement may lead to decreased access to quality foot and ankle care.

Trends in Medicare Reimbursement for Adult Cardiothoracic Surgery Procedures: 2007 to 2020

“…Tis trend is consistent with fndings from Levitski (1996) regarding reductions in Medicare reimbursements over time for cardiac surgery [9]. Decreasing Medicare reimbursement rates over time have also been reported in other felds such as neurosurgery (25.8% decline, CAGR −1.66%), general surgery (24.4% decline, CAGR −1.6%), reconstructive plastic surgery (14% decline, CAGR −0.8%), oral maxillofacial surgery (13.4% decline, CAGR −0.88%), orthopedic trauma surgery (30% decline, CAGR −1.5%), reconstructive microsurgery (26.92% decline, CAGR −1.35%), shoulder surgery (26.9% decline), and foot and ankle surgery (30% decline, CAGR −1.5%) [10][11][12][13][14][15][16][17].…”

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).…”