Trends in Payments for Ambulatory Surgery Center Facility Fees and Surgeon Professional Fees for Hip and Knee Arthroplasty.

Abstract

Background: Ambulatory Surgery Centers (ASCs) have been shown to deliver high-quality care to patients at major cost savings to the healthcare system. The objective of this investigation was to examine trends in the Medicare facility and surgeon professional fee payments for hip and knee arthroplasty.

Methods: Publicly available Medicare data was analyzed to determine professional and facility fee payments for unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and total hip arthroplasty (THA) to ASCs and hospitals between 2018 and 2024. The Physician Fee Schedule Lookup Tool and the Medicare ASC Payment Rates files were used to determine professional fee payments and facility fee reimbursements, respectively. Descriptive statistics were used to calculate means and percent change over time. The compound annual growth rates (CAGR) were calculated.

Results: After adjusting for inflation, Medicare professional fees declined significantly over the study period for UKA ($1,487.44 versus $1,147.50; P = 0.003), TKA ($1,738.99 versus $1,278.59; P = 0.003), and THA ($1,740.73 versus $1,280.52; P = 0.003). Medicare ASC facility fees also declined, albeit to a lesser degree for UKA ($9,007.62 versus $8,905.71; P = 0.764), TKA ($10,204.46 versus $9,048.76; P = 0.027), and THA ($9,982.66 versus $9,238.05; P = 0.308). Facility fee reimbursement decreased year over year, with annual percent change ranging from -0.19% for UKA to -2.49% for THA. Trends in Medicare hospital facility fees directly mirrored ASC facility fees over the study period. Professional fees also declined year over year, with annual percent changes ranging from -3.81% for UKA to -4.41% for TKA and THA.

Conclusions: The ASC facility fees and professional fees both declined over the study period, with declines in professional fees far outpacing those of facility fees. Urgent reform of the Medicare payment structure is needed to ensure orthopaedic practice solvency and access to high-quality care for beneficiaries.