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Physician Reimbursement is Declining and Facility Fee Reimbursement is Increasing for Orthopedic Procedures in the United States

Published:October 04, 2022DOI:https://doi.org/10.1016/j.arthro.2022.08.040

      Abstract

      Purpose

      The purpose of the study was to examine the trends in physician professional fees and inpatient and outpatient facility fees in orthopedic surgery in the United States.

      Methods

      Physician professional fees and inpatient and outpatient facility fees were tracked from 2008-2021 for the most common orthopedic procedures in each orthopedic subspecialty. Utilizing common procedure codes for physician and outpatient procedures and MS-DRG codes for inpatient procedures, the Medicare Physician Fee Schedules were used to obtain the national payment amounts for physician professional fees and inpatient and outpatient facility fees. Trends in fees were tracked over time after adjustment for inflation.

      Results

      From 2008 to 2021, physician professional fees decreased by an average of 20%, while inpatient facility fees increased by 15%, and outpatient facility fees increased by 72%. The orthopedic subspecialty with the largest decrease in physician professional fees was oncology, with an average decrease of 23.5%, followed by general orthopedics (23.1%), and sports medicine (22.8%). The largest increase in outpatient facility fees was seen in the subspecialties of general orthopedics (149.8%), spine (130.1%), and trauma (123.0%).

      Conclusion

      Over the past 13 years, physician professional fees for the most common orthopedic procedures have declined while inpatient and outpatient facility fees have increased. Understanding these changes is important to the practice of orthopedic surgery in the United States.

      Level of Evidence

      Economic IV

      Key Words

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      References

      1. NHE Fact Sheet | CMS. Accessed March 26, 2022. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet

      2. Orthopedic surgery spending increased 44 percent since 2010. Healthcare Finance News. Accessed January 30, 2021. https://www.healthcarefinancenews.com/news/orthopedic-surgery-spending-increased-44-percent-2010

        • Saleh K.J.
        • Shaffer W.O.
        Understanding Value-based Reimbursement Models and Trends in Orthopaedic Health Policy: An Introduction to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
        J Am Acad Orthop Surg. 2016; 24: e136-e147https://doi.org/10.5435/JAAOS-D-16-00283
        • Carter Clement R.
        • Bhat S.B.
        • Clement M.E.
        • Krieg J.C.
        Medicare reimbursement and orthopedic surgery: past, present, and future.
        Curr Rev Musculoskelet Med. 2017; 10: 224-232https://doi.org/10.1007/s12178-017-9406-7
        • Malik A.T.
        • Khan S.N.
        • Goyal K.S.
        Declining Trend in Medicare Physician Reimbursements for Hand Surgery From 2002 to 2018.
        J Hand Surg. 2020; 45: 1003-1011https://doi.org/10.1016/j.jhsa.2020.08.010
        • Meyers J.E.
        • Wang J.
        • Khan A.
        • Davies J.M.
        • Pollina J.
        Trends in Physician Reimbursement for Spinal Procedures Since 2010.
        Spine. 2018; 43: 1074-1079https://doi.org/10.1097/BRS.0000000000002516
        • Mayfield C.K.
        • Haglin J.M.
        • Levine B.
        • Della Valle C.
        • Lieberman J.R.
        • Heckmann N.
        Medicare Reimbursement for Hip and Knee Arthroplasty From 2000 to 2019: An Unsustainable Trend.
        J Arthroplasty. 2020; 35: 1174-1178https://doi.org/10.1016/j.arth.2019.12.008
        • Eltorai A.E.M.
        • Durand W.M.
        • Haglin J.M.
        • Rubin L.E.
        • Weiss A.P.C.
        • Daniels A.H.
        Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.
        Orthopedics. 2018; 41: 95-102https://doi.org/10.3928/01477447-20180226-04
        • Horst P.K.
        • Choo K.
        • Bharucha N.
        • Vail T.P.
        Graduates of Orthopaedic Residency Training Are Increasingly Subspecialized: A Review of the American Board of Orthopaedic Surgery Part II Database.
        J Bone Joint Surg Am. 2015; 97: 869-875https://doi.org/10.2106/JBJS.N.00995
      3. Physician Fee Schedule Look-Up Tool | CMS. Accessed January 30, 2021. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup

      4. Hospital Outpatient PPS | CMS. Accessed January 30, 2021. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index?redirect=/HospitalOutpatientPPS

      5. Ambulatory Surgical Center (ASC) Payment | CMS. Accessed January 30, 2021. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment

      6. Acute Inpatient PPS | CMS. Accessed January 30, 2021. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS

        • Malik A.T.
        • Kopechek K.J.
        • Bishop J.Y.
        • Cvetanovich G.L.
        • Khan S.N.
        • Neviaser A.S.
        Declining trends in Medicare physician reimbursements for shoulder surgery from 2002 to 2018.
        J Shoulder Elbow Surg. 2020; 29: e451-e461https://doi.org/10.1016/j.jse.2020.02.005
        • Pollock J.R.
        • Richman E.H.
        • Estipona B.I.
        • et al.
        Inflation-Adjusted Medicare Reimbursement Has Decreased for Orthopaedic Sports Medicine Procedures: Analysis From 2000 to 2020.
        Orthop J Sports Med. 2022; 1023259671211073720https://doi.org/10.1177/23259671211073722