Abstract
Background
There has been 25-year trend of decreasing value for orthopedic surgical work based
on the Resource-Based Relative Value Scale (RBRVS) for Medicare reimbursement. This
study was undertaken to estimate the time that Medicare payment rates for time spent
in the office doing cognitive work will equal time dedicated in the operating room
to performing procedural work based on long-term negative payment trends.
Methods
The RBRVS Update Committee database was accessed to extract the time elements for
2 procedures, total knee arthroplasty and total hip arthroplasty (27447 and 27130),
on the day of surgery. The evaluation and management code mix for 2 mid-sized orthopedic
practice was averaged to create an amalgamated rate for the reimbursement of office
work on an hourly rate. A graph of the 25-year trend line in Medicare reimbursement
for arthroplasty procedures was used to create a trend line. The trend line was then
extrapolated to estimate the time in the future that the hourly rate for office work
would equal the hourly rate for surgery.
Results
Time inputs and the Medicare conversion factor for 2021 were used in this analysis.
Total procedural time for both 27447 and 27130 was 204 minutes (3.4 hours) on the
day of surgery. An amalgamated hourly office rate of 7.9 relative value unit was calculated
from the average of the 2 mid-sized private practices for an overall in office Medicare
reimbursement of $318.89/h, with $1083.04 for the 3.4 hours allowed in the RBRVS Update
Committee database for a joint replacement. When the trend line for reimbursement
was extrapolated to the $1083.04 price point, the year corresponding to the point
where hourly office reimbursement would equal hourly surgical work was 2024.
Conclusion
Policymakers in Washington and practicing orthopedic surgeons need to consider the
looming economic parity of surgical and cognitive work for Medicare. Continued negative
reimbursement rates are likely to decrease patient access to necessary surgical care
and result in de facto rationing of arthroplasty services for Medicare patients. The
deployment of the orthopedic workforce is likely to change to accommodate the decreases
in the value of surgical work. This trend will have significant impact on the practice
of musculoskeletal medicine and patient access to orthopedic services.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- AAOS Now 2012.([accessed 06.05.20])
- Medicare reimbursement for hip and knee arthroplasty from 2000 to 2019: an unsustainable trend.J Arthroplasty. 2020; 35: 1174-1178
- A comprehensive analysis of Medicare reimbursement to physicians for common arthroscopy procedures: adjusted reimbursement has fallen nearly 30% from 2000 to 2019.Arthrosc Relat Surg. 2021; 37
- Editorial commentary: A rigged game—surgeon reimbursement under the resource-based relative value scale, current procedural terminology, and the affordable Care act.J Arthrosc Relat Surg. 2020; 36: 2364-2366
- Diffusion of Medicare’s RBRVS and related physician payment policies.Health Care Financ Rev. 1994; 16: 159-173
- 2021 CMS FFS.([accessed 06.05.21])
Kurtz S Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030 2007; 89: 780-785.
- Orthopedic practice in the US 2018 American Academy of Orthopedic Surgeons Department Clinical Quality and Value January. 2019 ([accessed 06.05.21])
Article info
Publication history
Published online: May 18, 2021
Accepted:
May 12,
2021
Received in revised form:
May 6,
2021
Received:
March 16,
2021
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2021.05.016.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
