The Journal of the American Academy of Orthopaedic Surgeons · 2025
Falling Rates of Public Orthopaedic Surgery Reimbursements and Utilization, 2016 to 2024.
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Branden Lee, Levin Adam S
Аннотация
BACKGROUND: Declining reimbursement rates can lead to decreased access and utilization of common orthopaedic surgeries for patients on Medicare, which is a particularly vulnerable population for musculoskeletal injuries.
METHODS: Using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool from 2016 to 2024 and utilization data for Medicare and part B beneficiaries from 2016 to 2022, we analyzed reimbursement and utilization trends. Simple linear regressions were executed to measure the annual trends, and Wilcoxon matched-pairs signed rank test were used to analyze the statistical significance of price and utilization changes.
RESULTS: Between 2016 and 2024, mean reimbursements for all evaluated orthopaedic surgeries decreased 26.2% with a -3.34% compound annual growth rate, from $1,558 to $1,150 ( P < 0.0001). Comparatively, reimbursement rates for evaluation and management (E/M) services fell by 15.82% or a -1.91% compound annual growth rate, from $102.3 to $86.12 ( P < 0.0021). The federal utilization of all orthopaedic surgeries fell from 2016 to 2022 ( P < 0.0001), although no significant changes were seen for E/M services ( P = 0.9102).
CONCLUSION: We observe that Medicare reimbursement rates for orthopaedic surgeries from 2016 to 2024 have fallen consistently with a large drop in utilization, especially during the Covid-19 pandemic. Reimbursements for E/M services have fallen at attenuated rates with minimal changes in utilization. This demonstrates the supportive role that declining reimbursement rates may play in utilization and accessibility of orthopaedic surgery.
METHODS: Using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool from 2016 to 2024 and utilization data for Medicare and part B beneficiaries from 2016 to 2022, we analyzed reimbursement and utilization trends. Simple linear regressions were executed to measure the annual trends, and Wilcoxon matched-pairs signed rank test were used to analyze the statistical significance of price and utilization changes.
RESULTS: Between 2016 and 2024, mean reimbursements for all evaluated orthopaedic surgeries decreased 26.2% with a -3.34% compound annual growth rate, from $1,558 to $1,150 ( P < 0.0001). Comparatively, reimbursement rates for evaluation and management (E/M) services fell by 15.82% or a -1.91% compound annual growth rate, from $102.3 to $86.12 ( P < 0.0021). The federal utilization of all orthopaedic surgeries fell from 2016 to 2022 ( P < 0.0001), although no significant changes were seen for E/M services ( P = 0.9102).
CONCLUSION: We observe that Medicare reimbursement rates for orthopaedic surgeries from 2016 to 2024 have fallen consistently with a large drop in utilization, especially during the Covid-19 pandemic. Reimbursements for E/M services have fallen at attenuated rates with minimal changes in utilization. This demonstrates the supportive role that declining reimbursement rates may play in utilization and accessibility of orthopaedic surgery.