Ankle Docs See Falling Medicare Payments

https://www.medpagetoday.com/meetingcoverage/aaos/103471

Inflation-adjusted reimbursements for fusion, joint replacement slip

LAS VEGAS — From 2000 to 2020, Medicare reimbursements for ankle arthroplasty have fallen more than 30% after adjusting for inflation, and payments for ankle arthrodesis declined nearly 7%, a researcher said here.

Meanwhile, the volume of these procedures has more than doubled over that time, according to Olufunmilola Adeleye, MBA, a medical student with the Mayo Clinic in Scottsdale, Arizona.

“These trends should be understood and considered by surgeons, healthcare administrators, and policy-makers in order to develop and implement agreeable models of reimbursement while ensuring access to quality surgical orthopedic foot and ankle care in the United States,” she told attendees at the American Academy of Orthopaedic Surgeons’ annual meetingopens in a new tab or window.

She noted that, as Medicare moves away from its traditional fee-for-service model, there may be opportunities for exactly such conversations.

Physicians in all specialties have long complained about inadequate and seemingly arbitrary payment schedules in Medicare. Now they may have more ammunition to back that argument.

Adeleye and colleagues pulled Medicare reimbursement data for diagnostic codes related to ankle replacement and joint fusion for 2000-2020, along with changes in the consumer price index that the group used to adjust for inflation.

The researchers counted just over 100,000 such procedures performed during these 2 decades. Rates soared from 0.88 per 10,000 beneficiaries in 2000 to 1.98 per 10,000 in 2020. Adeleye and colleagues also found that arthroplasties increasingly dominated the landscape.

Payments for arthrodesis averaged about $1,200 in 2000, while for total arthroplasty the mean reimbursement was roughly $950. Payments for both procedures declined substantially and steadily at about the same rates through 2010. At that point, the inflation-adjusted means for arthrodesis and arthroplasty were about $950 and $700, respectively.

In the second decade, average reimbursement for arthrodesis recovered somewhat, ending at $1,150. But payment for arthroplasty continued to fall, below $650 as of 2020. Overall, the declines were 6.91% and 30.15%, respectively.

“Your study made me very sad,” quipped session co-moderator Christopher Gross, MD, of the Medical University of South Carolina in Charleston, during the discussion after Adeleye’s presentation.

Gross told MedPage Today that he knew of no real reason for the decline in Medicare reimbursement. If anything, he said, these arthroplasties and arthrodesis procedures are more costly than ever. Implants have become dramatically more expensive and now clinicians may use patient-specific instrumentation. “That’s another $1,500,” he said. He acknowledged that average operative time may be shorter “by maybe 30 minutes,” but that is more than offset by increases in most other costs.

His feeling is that CMS is simply trying to save money with a special focus on procedures for elderly, whose numbers are rapidly growing as Baby Boomers age. Medicare payments don’t appear to reflect actual costs but are merely arbitrary, he said.

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