Free Falling: Declining Inflation-Adjusted Payment for Arthroplasty Surgeons.

Area of Science:

• Orthopedic Surgery
• Health Economics
• Healthcare Policy

Background:

• Concerns exist regarding declining surgeon compensation for lower extremity arthroplasty procedures.
• Analysis focuses on unicompartmental arthroplasty (UKA) and total knee (TKA) and hip (THA) arthroplasty (primary and revision).

Purpose of the Study:

• To determine changes in surgeon payment, patient charges, and reimbursement rates for UKA, primary/revision TKA, and primary/revision THA.
• To analyze inflation-adjusted financial trends from 2012 to 2017 using Medicare data.

Main Methods:

• Utilized Medicare data from 2012 to 2017.
• Calculated inflation-adjusted annual changes in surgeon payment (professional fee), patient charges, and reimbursement rate (payment-to-charge ratio).
• Employed both nonweighted and weighted (by procedure frequency/volume) means for analysis.

Main Results:

• Inflation-adjusted surgeon payment decreased for primary TKA (-17%) and THA (-11%), but increased for UKA (+30%).
• Reimbursement rates declined for all procedures: UKA (-15%), TKA (-14%), and THA (-10%).
• Weighted analysis showed slight charge decrease (-0.7%), with sharper drops in surgeon payment (-13%) and reimbursement rate (-12%).

Conclusions:

• Patient charges have kept pace with inflation for TKA and THA, but surgeon payment and reimbursement rates have fallen sharply.
• The orthopedic community must address these financial trends to advocate for a sustainable payment infrastructure with payers and policymakers.