Declining Orthopaedic Shoulder and Elbow Surgery Medicare Reimbursement Rates from 2000 to 2019
Authors: Pollock Jordan , Haglin Jack , Bingham Joshua , Moore Michael 
Published: July 2020

Objectives:

In the field of orthopaedics, it has been evident that Medicare reimbursement rates have been relatively stagnant. Although, objective measures of how these financial trends have changed over the past couple of decades has been limited. If orthopaedic practitioners and hospital administrators wish to make progress and advance the degree of satisfactory reimbursement they can expect, a more thorough understanding of these trends is warranted. In this study, the field of orthopaedic shoulder, elbow, and upper arm surgery is being analyzed specifically. The objective of this analysis was to assess the monetary trends in Medicare reimbursement rates for the 10 most commonly utilized shoulder surgical procedures and the 10 most commonly utilized elbow and upper arm surgical procedures from 2000 to 2019.

Methods:

For this analysis, the current procedural terminology (CPT) code ranges that corresponded to “Surgical Procedures of the Shoulder” and “Surgical Procedures of the Humerus (Upper Arm) and Elbow” were determined. The Medicare Provider Utilization and Payment Data: Physician and Other Suppliers PUF CY 2017 document was then utilized to objectively determine the 10 most common CPT codes fororthopaedic shoulder surgical procedures and orthopaedic elbow and upper arm surgical procedures. The reimbursement data for each of these procedures was then compiled from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services. All monetary data points were adjusted for inflation to 2019 US dollars utilizing changes to the United States consumer price index. The average annual and the total percentage change in reimbursement were based on the adjusted trends for the 10 included shoulder procedures and the 10 included elbow and upper arm procedures.

Results:

After adjustment for inflation, the average reimbursement for the top 10 orthopaedic shoulder surgery procedures decreased by 25.8% from 2000 to 2019. The greatest mean decrease was observed in the “Repair of ruptured musculotendinous cuff (e.g. rotator cuff) open; chronic (23412)” CPT code (-40.1%). No adjusted reimbursement rates were noted to be positive throughout the study period for surgical shoulder procedures. The procedure with the smallest mean decrease was the “Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation (23600)” CPT code (-5.4%). From 2000 to 2019, the adjusted reimbursement rate for all included shoulder procedures decreased by an average of 1.6% per year. For the top 10 orthopaedic elbow and upper arm surgical procedures, the average reimbursement decreased by 19.5% from 2000 to 2019. The greatest mean decrease was observed in the “Osteoplasty,humerus (e.g., shortening or lengthening) (24420)” CPT code (-32.1%). The procedure with the only positive mean difference was “Closed treatment of humeral shaft fracture; without manipulation (24500)” CPT code (0.34%). From 2000 to 2019, the adjusted reimbursement rate for all included elbow and upper arm procedures decreased by an average of 1.2% per year.

Conclusion:

To our knowledge, this is the first study to evaluate the orthopaedic shoulder and elbow subspecialtyand its trends in Medicare reimbursement rates. When monetary data is corrected for inflation, Medicare reimbursement rates have shown a steady decline from 2000 to 2019. The 10 most common procedures of or relating to the shoulder have decreased by an average of 25.8% while the 10 most common procedures of or relating to the elbow or upper arm have decreased by an average of 19.5%. Additionally, only one procedure showed a positive increase in reimbursement rate (Closed treatment of humeral shaft fracture; without manipulation (24500)). If access to high quality and sustainable surgicalorthopaedic care is to persist in the United States, increased awareness of these trends is important for stakeholders to take note of.