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Medicare reimbursement rates for orthopedic trauma have fallen sharply

September 22, 2020 / Jeff Lagasse, Associate Editor

The amount Medicare reimburses for orthopedic trauma surgery has fallen by nearly one-third over the past two decades, reports a study in the Journal of Orthopaedic Trauma. When adjusted for inflation, reimbursement for common procedures in this specialty has steadily decreased from 2000 to 2020.

With increasing volumes and the costs associated with medical practice, Kenneth A. Egol and colleagues in the Department of Orthopedic Surgery at NYU Langone Health in New York said that change will be necessary to ensure the financial health and success of physicians and hospitals caring for orthopedic trauma patients.

Using publicly available data from the Centers for Medicare and Medicaid, the authors examined reimbursement trends for the 20 most commonly billed surgical-procedure codes in orthopedic trauma from 2000 to 2020 – the majority of which are traumatic bone fractures requiring surgical repair with some type of hardware, known as internal fixation. Costs were adjusted for inflation to 2020 dollars, based on the Consumer Price Index.

Over that time, the CPI – a widely used measure of inflation – increased by 52.8%. Meanwhile, average Medicare reimbursement for the 20 orthopedic trauma surgery procedures rose by only 4.9%, failing to keep up with increases in the cost of living.

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Chris J. Stewart

Chris currently serves as Chief Executive Officer of Surgio Health as well as COO at Ortho Spine Partners. Chris has close to 20 years of healthcare management experience with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that solve real problems that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help drive better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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