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Arthroscopy Patients in Medicare Population Became Sicker While Reimbursement Decreased From 2013 to 2020
Jack M Haglin1, Joseph C Brinkman1, Eugenia Lin1
1Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A.
Purpose:
To assess surgeon reimbursement for common arthroscopic procedures, including arthroscopic meniscal debridement and arthroscopic rotator cuff repair, in patients with differing risk profiles within the Medicare population.
Methods:
A publicly available Medicare database was used to identify all cases of arthroscopic meniscal debridement and arthroscopic rotator cuff repair procedures billed to Medicare from 2013 to 2020. The surgeon reimbursement from Medicare was collected and adjusted for inflation. All procedure episodes were split into 2 cohorts; those with a hierarchical condition category (HCC) risk score ≥1.5, and those with patient HCC risk scores <1.5. Reimbursement rates were compared between groups.
Results:
From 2013 to 2020, a total of 624,077 meniscal debridement procedures and 567,794 arthroscopic rotator cuff repairs were billed to Medicare Part B. During this time, the mean adjusted surgeon reimbursement for arthroscopic rotator cuff repair decreased by 9.2% from 2013 to 2020. During the same time period, the adjusted mean surgeon reimbursement for arthroscopic both compartment meniscal debridement and single compartment meniscal debridement decreased by 7.9% and 9.9%, respectively. Throughout the study period, the mean HCC risk score increased from 1.19 in 2013 to 1.31 in 2020 (P < .001). Across all years in the study, the sicker cohort had a significantly greater rate of all comorbidities and a greater mean body mass index (P < .001 for all variables). The mean reimbursement across this cohort was lower for both rotator cuff repair (P = .037) and meniscal debridement procedures (P < .001) compared with the healthier cohort.
Conclusions:
This study demonstrates that from 2013 to 2020, inflation-adjusted surgeon reimbursement for arthroscopic rotator cuff repair and meniscal debridement decreased while patient complexity increased. Further, mean surgeon reimbursement was lower among patients with more complexity in comparison with their healthier counterparts for such procedures.
Level Of Evidence:
Level III, retrospective cohort study.
Insights
Surgeon reimbursement for arthroscopic rotator cuff repair and meniscal debridement decreased from 2013-2020. Sicker patients with higher risk scores received lower payments for these common orthopedic procedures.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Medicare Reimbursement
Background:
- Surgeon reimbursement for common orthopedic procedures is crucial for practice viability.
- Understanding reimbursement trends in relation to patient complexity is essential for healthcare policy.
- Medicare beneficiaries represent a significant population undergoing arthroscopic procedures.
Purpose of the Study:
- To assess surgeon reimbursement for arthroscopic meniscal debridement and rotator cuff repair.
- To analyze reimbursement differences based on patient risk profiles (Hierarchical Condition Category - HCC risk score).
- To evaluate trends in surgeon reimbursement within the Medicare population from 2013 to 2020.
Main Methods:
- Utilized a publicly available Medicare database (2013-2020).
- Identified and collected data for arthroscopic meniscal debridement and rotator cuff repair procedures.
- Adjusted reimbursement for inflation and stratified patients by HCC risk score (≥1.5 vs. <1.5).
Main Results:
- Mean inflation-adjusted surgeon reimbursement decreased for both rotator cuff repair (-9.2%) and meniscal debridement (-7.9% to -9.9%) from 2013-2020.
- The mean HCC risk score for Medicare patients increased over the study period.
- Patients with higher HCC risk scores (≥1.5) had significantly lower mean reimbursement for both procedure types compared to lower-risk patients.
Conclusions:
- Inflation-adjusted surgeon reimbursement for key arthroscopic procedures declined between 2013 and 2020.
- Patient complexity, indicated by higher HCC risk scores, increased during this period.
- Surgeons were reimbursed less for operating on more complex patients undergoing rotator cuff repair and meniscal debridement.
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