Tag Archive | Medicare reimbursement

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. 

 

Reimbursement for Revision TKA Has Not Kept Pace with Inflation

I was once told that if you don’t have any cases with complications, you either aren’t operating enough or aren’t following your patients. Although we in the orthopaedic community make every effort to minimize the occurrence of patient complications, one that remains difficult to eradicate is periprosthetic joint infection (PJI), which is a leading cause of revision total knee arthroplasty (TKA). The welfare of our patients requires successfully addressing this potentially devastating outcome, but reimbursement for these complex cases has decreased over the past decade.

In the upcoming issue of JBJS, Jella et al. offer insight on temporal trends in Medicare physician reimbursement for revision TKA. They queried the Medicare Physician Fee Schedule Look-Up Tool for pricing information corresponding to 1 and 2-stage revision TKAs and used monetary data from Medicare Administrative Contractors to calculate nationally representative means. The authors evaluated aseptic revision of 1 component, 1-stage revision (aseptic or septic), and both the first and second stages of a 2-stage septic revision.

They found that, from 2002 to 2019, there was a mild increase in the physician fee for each CPT code, with the exception of that for second-stage implantation. However, after adjusting for inflation, total Medicare reimbursements declined for both septic and aseptic revision TKAs (between 23% and 33%), with a significantly greater decline observed for septic revision.

The authors also found that Medicare spending on aseptic revision TKA nearly doubled from 2004 to 2017, while spending on septic revision TKA increased only slightly. They note that a main driver of the discrepancy between septic and aseptic revision may be the reimbursement for the second stage of the former procedure using CPT 27447 instead of a revision procedure code (27487).

We know that an increase in revision TKAs (both septic and aseptic) is expected as the number of primary TKA procedures continues to rise. If reimbursement doesn’t keep pace, it is likely to drive certain surgeons away from tackling the sometimes difficult cases, in turn, leaving our patients with fewer available resources when faced with PJI.

Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media