Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016

Eltorai, Adam E.M.; Durand, Wesley M.; Haglin, Jack M.; Rubin, Lee E.; Weiss, A.-P. C.; Daniels, Alan H.

doi:10.3928/01477447-20180226-04

Cited by 91 publications

(80 citation statements)

References 16 publications

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“…When compared with other surgical subspecialties, orthopaedic reimbursements have been reported to be declining at a greater rate. 11 Orthopaedic surgeons are being reimbursed less while balancing increased responsibilities tied to bundled payments, readmission penalties, and a multitude of quality metrics. 7 , 20 Conversely, hospital CEO compensation increased by 93% between 2005 and 2015 during a period of decreased Medicare orthopaedic surgeon reimbursement.…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 20 Conversely, hospital CEO compensation increased by 93% between 2005 and 2015 during a period of decreased Medicare orthopaedic surgeon reimbursement. 9 , 11 While surgeon reimbursement is becoming more heavily tied to patient outcomes, 7 , 20 hospital CEO salaries have not been reported to be positively associated with improved patient outcomes, quality performance, or hospital margins. 9 , 15 Lack of “physician-hospital alignment” in the orthopaedic community is often centered on financial issues.…”

Section: Discussionmentioning

confidence: 99%

“… 18 , 29 Unsurprisingly, there has been an increased focus on the economics of arthroscopic partial meniscectomies given the sheer volume and the estimated $4 billion in annual direct costs 29 in the United States associated with performing these operations. 11 , 21 , 24 , 29 Health care costs represent a significant concern to Americans, and it is expected that national health expenditures will increase to 19.4% of the US gross domestic product by 2027. 30 …”

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confidence: 99%

“… 13 Medicare reimbursements also decreased between 2000 and 2016 for the majority of the most common orthopaedic surgeries. 11 While orthopaedic surgeon payments have decreased, or stayed the same, for many common procedures, hospital payments have increased considerably.…”

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confidence: 99%

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Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

LaPrade

Camp

Krych

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Charge and reimbursement trends for arthroscopic partial meniscectomies among orthopaedic surgeons, anesthesiologists, and hospital/surgery centers have not been formally analyzed, even though meniscectomies are the most commonly performed orthopaedic surgery. Purpose: To analyze Medicare charge and reimbursement trends for surgeons, anesthesiologists, and hospital/surgery centers for outpatient arthroscopic partial meniscectomies performed in the United States. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: We analyzed trends in surgeon, anesthesiologist, and hospital charges and reimbursements for outpatient isolated arthroscopic partial meniscectomies from 2005 to 2014. Current Procedural Terminology codes were used to capture charge and reimbursement information using the nationally representative 5% Medicare sample. National and regional trends for charge, reimbursement, and Charlson Comorbidity Index (CCI) were evaluated using linear regression analysis. Results: A total of 31,717 patients were analyzed in this study. Charges across all groups increased significantly ( P < .001) during the 10-year study period, with an increase of 18.4% ($2754-$3262) for surgeons, 85.5% ($802-$1480) for anesthesiologists, and 116.8% ($2743-$5947) for hospitals. Surgeon reimbursements declined by 15.5% ($504-$426; P = .072) during this period. Anesthesiologist and hospital reimbursements increased significantly during by 36.5% ($133-$182; P < .001) and 28.9% ($1540-$1984; P < .001) during the 10-year study period, respectively. The annual incidence of partial meniscectomies per 10,000 database patients decreased significantly from 18.3 to 15.6 over the course of the study (14.8% decrease; P = .009), while the CCI did not change significantly ( P = .798). Conclusion: Hospital and anesthesiologist Medicare reimbursements for outpatient arthroscopic partial meniscectomies increased significantly, while surgeon reimbursements decreased. In 2005, hospitals were reimbursed 205% more ($1540 vs $504) than surgeons, and by 2014, they were reimbursed 365% more ($1984 vs $426), indicating that the gap between hospital and surgeon reimbursement is rising. Improved understanding of charge and reimbursement trends represents an opportunity for key stakeholders to improve financial alignment across the field of orthopaedics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

LaPrade

Camp

Krych

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…25 Similarly, an analysis of Medicare claims for orthopedic surgery published by Eltorai et al showed that, except for removal of an orthopedic implant, common orthopedic procedures showed a decrease in reimbursement from 2000 to 2016. 23…”

Section: Discussionmentioning

confidence: 99%

A Critical Analysis of Medicare Claims for Otolaryngology Procedures

Youssef

2019

Otolaryngol.--head neck surg.

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Objective This study was performed to outline and analyze the overall Medicare landscape with respect to otolaryngologists and beneficiaries, services, and reimbursements. Methods This is a retrospective analysis of publicly available Medicare utilization and payment data for all otolaryngologists in facility and nonfacility practice settings who provided services to Medicare beneficiaries between January 1, 2012, and December 31, 2016. Results In 2016, a total of $701,195,375 was distributed to 8572 otolaryngology physician providers for 815 unique Healthcare Common Procedure Coding System codes for 13,942,536 procedure claims. Of specialty care, otolaryngology ranks 20th among 54 subspecialties for total Medicare payments. The average number of services coded per provider was 1627. The average otolaryngologist was paid $81,800.67. Thirty-two percent of otolaryngologists did not receive reimbursement for services from Medicare in 2016. Discussion In 2016, the most significant contributors to Medicare payments to otolaryngologists were large-scale, low-cost events that are relatively short procedures done in clinic. Utilization of nasal endoscopy was up trending from 2012 to 2016. Some of the Current Procedural Terminology codes with the greatest discrepancies between submitted charge and Medicare payment among nonfacility otolaryngology providers are more involved than simple office procedures. Implications for Practice It is increasingly valuable for physicians to know factors that affect reimbursement for procedures and operations in different settings and to be aware of the trends in variation in their specialty. Otolaryngologists should communicate with policy makers in efforts toward sustainable reimbursement models.

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