Differences in Medicare payment and practice characteristics for orthopedic surgery subspecialties

Medicare payment, practice, and patient characteristics give perspective on the lifestyle, challenges, and attractiveness unique to each orthopedic surgery subspecialty. Changes to Medicare reimbursement may also affect health care delivery, warranting policy change. We analyzed differences in orthopedic surgery subspecialty characteristics and Medicare payments.

The Centers for Medicare and Medicaid Services data set was filtered by Current Procedural Terminology (CPT) codes unique to each orthopedic surgery subspecialty in 2019. After filtering by unique CPT codes, 100 randomized physicians were validated for each subspecialty: adult reconstruction and arthroplasty, trauma, sports medicine, hand surgery, shoulder and elbow surgery, foot and ankle surgery, and spine surgery. Data gathered included unique procedural codes, number of beneficiaries, services provided, and the total Medicare allowed amount. Differences were assessed with post hoc tests. Subspecialty changes in Medicare payment were assessed using the Physician Fee Schedule and compared using a single-factor analysis of variance.

On average, hand surgery recorded the most unique CPT codes (106) and the highest volume of beneficiaries (571). Adult reconstruction and arthroplasty had the fewest unique codes (60) and the greatest total Medicare payment ($328,000). Spine surgery had the lowest number of beneficiaries (387) and lowest number of services provided (1752). Lastly, sports medicine provided the largest volume of services (4221). Mean total codes, unique codes, and total patients differed between subspecialties. Varying differences in average Medicare payment, total billed codes, total unique codes, total patients, patient race, patient age, patient sex, and patient health were found for all orthopedic surgery subspecialties in 2019.

These data may illustrate financial incentives for orthopedic surgery residents to pursue certain subspecialties.