Trends in Surgeon Reimbursement for Primary Total Hip and Knee Joint Arthroplasty: An Analysis of 2,421,710 Medicare Part B Claims From 2017 to 2022.

Abstract

Background: Primary hip and knee total joint arthroplasties (TJAs) are among the most frequently performed orthopaedic surgeries in the United States, with demand projected to increase to two million cases per year by 2040. Despite the growing demand, previous studies have shown a declining value of Medicare surgeon reimbursements. Given recent inflationary trends, an updated analysis of the changing value of primary TJA reimbursement is necessary. This study examines surgeon reimbursement trends for primary TJA among Medicare patients from 2017 to 2022.

Methods: We analyzed Medicare Part B claims data from the Centers for Medicare and Medicaid Services Medicare Physician & Other Practitioners database. Using Healthcare Common Procedure Coding System codes for primary TJA, we queried the database for procedures performed between 2017 and 2022. Yearly service counts and allowed Medicare reimbursements were examined. Reimbursement values were adjusted for inflation using the Consumer Price Index with all values converted to 2022 U.S. dollars.

Results: The study included 2,421,710 Medicare claims for primary TJA from 2017 to 2022. During this period, the volume of primary TJA increased by 2.9%. However, average reimbursement decreased by 4.2%, from $1,343 in 2017 to $1,286 in 2022. When adjusted for inflation, the decrease in reimbursement was more pronounced, falling by 19.6% from $1,600 to $1,286. Trends in reimbursement varied by procedure type and geographic region.

Conclusion: Between 2017 and 2022, while the volume of primary TJA increased, Medicare surgeon reimbursement for these procedures decreased, with a markedly greater reduction when adjusted for inflation. These trends highlight the need for policy reforms to ensure sustainable reimbursement for surgeons performing primary TJA.