Afshin Anoushiravani, Amir Human Hoveidaei, Gabrielle N Swartz, Reza Katanbaf, James E Feng, Casey M O'Connor, James Nace D O M P T F A O A O, Michael A Mont, Ronald E Delanois
{"title":"Medicare Reimbursement Trends for Common Hip Arthroplasty Procedures: A Generational Perspective, 2006 to 2024.","authors":"Afshin Anoushiravani, Amir Human Hoveidaei, Gabrielle N Swartz, Reza Katanbaf, James E Feng, Casey M O'Connor, James Nace D O M P T F A O A O, Michael A Mont, Ronald E Delanois","doi":"10.1016/j.arth.2025.03.082","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the trends in Medicare reimbursement for common hip arthroplasty procedures from 2006 to 2024.</p><p><strong>Methods: </strong>This study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) from 2006 to 2024 to identify payment trends for the most common orthopaedic procedures related to hip arthroplasty. The study calculated Medicare reimbursement by multiplying Relative Value Units (RVUs) by a CMS-determined conversion factor and adjusted reimbursement rates for inflation to 2024 United States (U.S.) dollars using the Consumer Price Index (CPI) inflation calculator from the U.S. Department of Labor. Projections for future trends were derived from mean values from 2020 to 2024, with data visualizations created in Microsoft Excel.</p><p><strong>Results: </strong>From 2006 to 2024, total reimbursements for medical procedures dropped by 0.1%, while the CPI increased by 55%. This caused the average reimbursement to fall by 35.5%. The biggest decrease was in primary total hip arthroplasty reimbursement, which fell by 40.7%. Additionally, the unadjusted work reimbursement rate for all procedures went down by 6.1%, resulting in a substantial inflation-adjusted decrease of 39.4%. If these trends continue, projections for 2029 suggest an additional projected decline in surgeon reimbursement of 33 to 42%, and work reimbursements could drop by 40 to 50%.</p><p><strong>Conclusion: </strong>From 2006 to 2024, inflation-adjusted Medicare reimbursement for hip arthroplasty has dropped markedly, challenging orthopaedic practices' sustainability. This may lead healthcare providers to see more patients, risking burnout and affecting patient outcomes. Compensation for orthopaedic surgeons should reflect the patient value added. However, this study demonstrates a progressive decrease in physician reimbursement, which could lead to an unneeded financial burden on orthopaedic practices. The focus should be on advocating for better reimbursement policies to maintain practice integrity rather than just increasing patient volume.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arthroplasty","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arth.2025.03.082","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: This study aimed to assess the trends in Medicare reimbursement for common hip arthroplasty procedures from 2006 to 2024.
Methods: This study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) from 2006 to 2024 to identify payment trends for the most common orthopaedic procedures related to hip arthroplasty. The study calculated Medicare reimbursement by multiplying Relative Value Units (RVUs) by a CMS-determined conversion factor and adjusted reimbursement rates for inflation to 2024 United States (U.S.) dollars using the Consumer Price Index (CPI) inflation calculator from the U.S. Department of Labor. Projections for future trends were derived from mean values from 2020 to 2024, with data visualizations created in Microsoft Excel.
Results: From 2006 to 2024, total reimbursements for medical procedures dropped by 0.1%, while the CPI increased by 55%. This caused the average reimbursement to fall by 35.5%. The biggest decrease was in primary total hip arthroplasty reimbursement, which fell by 40.7%. Additionally, the unadjusted work reimbursement rate for all procedures went down by 6.1%, resulting in a substantial inflation-adjusted decrease of 39.4%. If these trends continue, projections for 2029 suggest an additional projected decline in surgeon reimbursement of 33 to 42%, and work reimbursements could drop by 40 to 50%.
Conclusion: From 2006 to 2024, inflation-adjusted Medicare reimbursement for hip arthroplasty has dropped markedly, challenging orthopaedic practices' sustainability. This may lead healthcare providers to see more patients, risking burnout and affecting patient outcomes. Compensation for orthopaedic surgeons should reflect the patient value added. However, this study demonstrates a progressive decrease in physician reimbursement, which could lead to an unneeded financial burden on orthopaedic practices. The focus should be on advocating for better reimbursement policies to maintain practice integrity rather than just increasing patient volume.
期刊介绍：
The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
