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Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy
Andrew G Kim1, Adam A Rizk, Jason G Ina
1From the Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
Insights
Medicare reimbursement for hip arthroscopy procedures decreased significantly from 2011 to 2021. After adjusting for inflation, all seven common hip arthroscopy services saw reduced physician fees.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Medical Reimbursement Analysis
Background:
- Hip arthroscopy is a frequently performed orthopedic procedure.
- There is a lack of comprehensive analysis on reimbursement trends for hip arthroscopy.
- Understanding reimbursement trends is crucial for healthcare providers and policymakers.
Purpose of the Study:
- To analyze the temporal trends in Medicare reimbursement for hip arthroscopy procedures.
- To evaluate changes in physician fees for hip arthroscopy services between 2011 and 2021.
Main Methods:
- Utilized Medicare Physician Fee Schedule data from 2011 to 2021.
- Analyzed Current Procedural Terminology (CPT) codes specific to hip arthroscopy.
- Adjusted all monetary values to 2021 US dollars to account for inflation.
- Employed Mann-Kendall trend tests to assess reimbursement trends.
Main Results:
- Unadjusted physician fees increased for CPT codes 29861 and 29862.
- After inflation adjustment, all seven hip arthroscopy CPT codes showed a decline in Medicare reimbursement.
- Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) experienced the largest reimbursement decreases (24.69% and 24.64%, respectively).
Conclusions:
- Medicare reimbursement for hip arthroscopy services has not kept pace with inflation.
- Significant real-dollar reductions in reimbursement occurred between 2011 and 2021 for all analyzed hip arthroscopy procedures.
- The findings highlight a concerning trend of decreasing reimbursement for essential orthopedic procedures.
Introduction:
Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures.
Methods:
From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends.
Results:
Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% ( P < 0.001) and 24.64% ( P < 0.001), respectively, over the study period.
Discussion:
Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.
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