Decrease in Inflation-Adjusted Medicare Reimbursement for Revision THA
In a study now reported in JBJS, Acuña et al. analyzed Medicare reimbursements associated with revision total hip arthroplasty (THA) procedures. After adjusting for inflation, they found that the mean physician fee reimbursement for revision THA due to aseptic complications declined by a mean of 27% for femoral component revision, 27% for acetabular component revision, and 28% for both-component revision from 2002 to 2019. For 2-stage revision due to infection, they found that mean reimbursement fell by 19% and 24% for the explantation and reimplantation stages, respectively.
The total decline in reimbursement for revision THA due to infection ($1,020.64 ± $233.72) was significantly greater than that for revision due to aseptic complications ($580.72 ± $107.22) (p < 0.00001).
Reflecting on their investigation, the authors note:
In light of persistent cost pressures and discussions surrounding the future of total hip arthroplasty reimbursement, our study explores temporal trends in the Centers for Medicare & Medicaid Services (CMS) physician fee schedule for revision THA procedures. Our findings, showing a significantly larger decline for septic revision THA reimbursements compared to their aseptic counterpart, may have important implications for ongoing discussions surrounding the CMS physician fee schedule.”
They conclude in their study that, “continuation of this trend [of decreased reimbursement] could create substantial disincentives for physicians to perform such procedures and limit access to care at the population level.”
Click here for the full JBJS report.
A recent OrthoBuzz post on reimbursement for revision TKA can be found here.