Care of low-income patients with sports injuries disincentivized by government reimbursement

Abstract

Objectives: The purpose of this study is to compare Medicaid reimbursement rates with regional Medicare reimbursement for 10 commonly performed orthopaedic sports medicine procedures. Design: Database review. Setting: State Medicaid physician fee schedules and national Medicare fee schedule. Intervention: Medicaid and Medicare reimbursement for meniscus debridement (medial or lateral), meniscus repair (medial or lateral), anterior cruciate ligament (ACL) reconstruction, posterior cruciate ligament (PCL) reconstruction, anterior labral (Bankart) repair, rotator cuff repair, biceps tenodesis, femoral osteochondroplasty, acetabular osteoplasty, and acetabular labral repair. Main outcome measurement: Overall Medicaid to Medicare reimbursement ratio, dollar difference between Medicaid and Medicare reimbursement, dollar difference between Medicaid and Medicare per relative value unit (RVU), dispersion of reimbursement rates. Results and conclusions: Significant discrepancies were found between Medicaid and Medicare reimbursement for all 10 procedures, with Medicaid reimbursing on average 65.15% of the Medicare rate. Medicaid reimbursement also exhibited substantial variation between individual state programs. Financial incentives matter and between these two government programs, orthopaedic surgeons are incentivized to provide care to elderly patients over poorer patients. Level of Evidence: IV; Economic Analysis Keywords: Medicaid; Medicare; Reimbursement; RVU; Variation (J Ortho Business 2021; 1:4-6)