Compensation Crisis: The Impact of Inflation and Declining Medicare Payments on Hip Arthroplasty Surgeons

Despite advances in total hip arthroplasty (THA) and revision THA (rTHA), declining reimbursement rates for orthopaedic surgeons threaten financial sustainability, particularly as case complexity and demand rise. This analysis focused on changes in Medicare payments from 2006 to 2022, adjusted for inflation, to assess trends in surgeon compensation and their implications.

Data were extracted from 2006 to 2022, utilizing Current Procedural Terminology codes for primary THA and rTHA to assess case complexity. Medicare's relative value unit (RVU) conversion factors and reimbursement rates were analyzed and adjusted for inflation using the consumer price index. Key metrics, including average reimbursement per case and per minute, were calculated, along with total percentage change and compound annual growth rate. Projected reimbursement rates for 2030 were also estimated.

Reimbursement rates for THA procedures have considerably declined in inflation-adjusted terms since 2006. Medicare reimbursement per work relative value unit decreased by 38%, and all five Current Procedural Terminology codes studied exhibited negative compound annual growth rate. By 2022, average reimbursements for primary THA and rTHA had dropped by 39.7 and 34.3%, respectively. On the other hand, the hospital share of Medicare payments has increased disproportionately compared to surgeon compensation, reflecting a trend toward reduced reimbursement for surgeon effort, complexity, and time.

The findings highlight a growing disparity in surgeon compensation despite increased patient demand and procedure complexity. Declining reimbursement pressurizes surgeons to increase productivity and efficiency, potentially leading to higher burnout rates and reduced willingness to perform revision cases. Medicare's failure to incorporate inflation adjustments for physician payments exacerbates this issue. As the field shifts toward value-based care, addressing surgeon reimbursement is critical to sustaining high-quality patient outcomes and fair compensation.

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