Boudreau Sellers C, Dombrowsky Alexander R, Arguello Alexandra M, Gould Stephen, Brabston Eugene W, Ponce Brent A, Momaya Amit M
From the Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham.
South Med J. 2020 Apr;113(4):191-197. doi: 10.14423/SMJ.0000000000001081.
Significant attention has been directed at evaluating reimbursement rates to orthopedic surgeons for various surgical procedures. To evaluate patients' understanding of the surgeon reimbursement process, studies using patient surveys have been conducted to determine patients' perceptions of orthopedic surgeon compensation. To date, there has been no systematic review to consolidate the data of these studies. This study aimed to synthesize the findings of these individual studies across multiple subspecialties of orthopedic surgery to evaluate the potential discrepancy between how much patients believe orthopedic surgeons are reimbursed and the actual reimbursement rate. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies that report findings of patient perceptions of orthopedic surgeon reimbursement for various procedures. Searches were conducted using MEDLINE through PubMed, Embase, and Scopus. Summary estimates of reimbursement discrepancies across subspecialties and overall were reported as unweighted averages of the individual study results within each group. Twelve studies were identified that met inclusion criteria, constituting 4309 surveys. These survey studies measured patients' perceptions of how much orthopedic surgeons are reimbursed for common procedures, including anterior cruciate ligament reconstruction, arthroscopic meniscectomy, carpal tunnel release, rotator cuff repair, multiple spine procedures and total shoulder, hip, and knee arthroplasty. It was found that patients reported reasonable surgeon's fees to be 11.2 times more than actual Medicare reimbursement. Among individual studies, the largest discrepancies were seen in total hip arthroplasty (26 times), whereas the smallest difference was in anterior cruciate ligament reconstruction (1.6 times). On average, patients estimated Medicare reimbursement rates to be 5.9 times higher than the actual surgeon reimbursement. Patients consistently overestimate how much orthopedic surgeons are reimbursed for common orthopedic procedures. The results of this systematic review suggest that patients may value these procedures more than what Medicare reimburses. Such information may help educate the public, direct policy, and increase transparency between orthopedic surgeons and patients.
人们已将大量注意力投向评估骨科医生进行各种手术的报销率。为了评估患者对医生报销流程的理解，已开展使用患者调查问卷的研究，以确定患者对骨科医生薪酬的看法。迄今为止，尚未进行系统综述来整合这些研究的数据。本研究旨在综合这些针对骨科手术多个亚专业的单项研究结果，以评估患者认为骨科医生获得的报销金额与实际报销率之间的潜在差异。我们按照系统评价与Meta分析的首选报告项目（PRISMA）指南进行了系统综述，以识别报告患者对各种手术中骨科医生报销看法的研究结果的研究。通过PubMed、Embase和Scopus使用MEDLINE进行检索。各亚专业及总体报销差异的汇总估计值报告为每组内单项研究结果的未加权平均值。共识别出12项符合纳入标准的研究，涵盖4309份调查问卷。这些调查研究测量了患者对骨科医生进行常见手术（包括前交叉韧带重建、关节镜下半月板切除术、腕管松解术、肩袖修复术、多种脊柱手术以及全肩关节、髋关节和膝关节置换术）的报销金额的看法。结果发现，患者报告的合理医生费用比医疗保险实际报销金额高11.2倍。在单项研究中，全髋关节置换术的差异最大（26倍），而前交叉韧带重建术的差异最小（1.6倍）。平均而言，患者估计医疗保险报销率比医生实际报销率高5.9倍。患者一直高估骨科医生进行常见骨科手术的报销金额。这项系统综述的结果表明，患者可能比医疗保险报销的价值更重视这些手术。此类信息可能有助于对公众进行教育、指导政策制定，并提高骨科医生与患者之间的透明度。
