Substantial Preoperative Work Is Unaccounted for in Total Hip and Knee Arthroplasty

Medicare reimbursement trends from 2000 to 2020 in head and neck surgical oncology

“…Given the complexity and the vague nature of RVU allocation to certain CPT codes, there is a great deal of uncertainty providers and hospitals face when it comes to reimbursement. Several studies have documented flaws in CMS reimbursement methodologies, especially given the tedious process of revaluation of CPT codes, often taking years of questioning and evaluation before going into effect 3,4 . Accordingly, inadequate compensation for certain procedure codes may risk disincentivizing the provision of certain services that are critical to head and neck surgical practices.…”

“…Several studies have documented flaws in CMS reimbursement methodologies, especially given the tedious process of revaluation of CPT codes, often taking years of questioning and evaluation before going into effect. 3,4 Accordingly, inadequate compensation for certain procedure codes may risk disincentivizing the provision of certain services that are critical to head and neck surgical practices. In this way, there is a growing need to characterize and understand reimbursement for otolaryngologic codes to appraise the valuation system and identify opportunities for change.…”

How the Shift in Arthroplasty Surgery Location Impacts the Relationship of Private Surgeons, Hospitals, and Ambulatory Surgery Centers

“…For surgeons, this has been primarily in the context of increased preoperative optimization and selection of appropriate surgical setting [1e3]. In a prospective series of primary hip and knee arthroplasty patients, our institution previously reported that for each patient nearly 2 hours of preoperative care by surgeons and advanced practice providers is unaccounted for by CMS valuation [1]. Hospitals have also been burdened by increasing perioperative work, particularly when patients are changed from "outpatient" to "inpatient" status with prolonged hospital stay [4].…”

Caring for Diverse and High-Risk Patients: Surgeon, Health System, and Patient Integration

“…While alternative payment models such as the Bundled Payments for Care Improvement initiative and the Comprehensive Care for Joint Replacement model have been successful in lowering wait times while improving value and access to care [56,57], it has become clear that Medicaid patients should not be included in traditional bundles as they require a substantial cost premium per episode of care [50]. One possible solution is a separate alternative payment model designed for high-risk populations that also accounts for the substantial perioperative work needed to yield successful options for this patient population [58].…”