From the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
J Am Acad Orthop Surg. 2021 Dec 1;29(23):e1232-e1238. doi: 10.5435/JAAOS-D-20-01397.
The purpose of this study was to compare surgeon professional fee reimbursement and trends from Medicare versus commercial payors for inpatient orthopaedic surgeries: total knee arthroplasty (TKA), total hip arthroplasty (THA), total shoulder arthroplasty (TSA), anterior cervical diskectomy and fusion (ACDF), and posterior lumbar fusion (PLF).
Patients undergoing TKA, THA, TSA, single-level ACDF, and single-level PLF from 2010 to 2018 were queried in a commercially insured claims database. Medicare reimbursements and the work relative value unit (wRVU) of each procedure were obtained from the Medicare Physician Fee Schedule. All costs were adjusted for inflation and reported in 2018 real dollars. Compound annual growth rates were calculated to assess the mean growth rate for each procedure. Linear regression was done to assess trends.
On average, payments from Medicare were 57% less than payments from commercial payors. From 2010 to 2018, both Medicare and commercial payments decreased significantly for each surgery (P < 0.05 for all). Compared with inflation-adjusted commercial payments, Medicare payments decreased 2.1 times faster for TKA (-2.1% versus -1.0%), 2.8 times faster for THA (-1.4% versus -0.5%), 1.3 times faster for TSA (-1.0% versus -0.8%), and 1.9 times faster for ACDF (-1.1% versus -0.6%). PLF was the only procedure for which Medicare payments declined slower than commercial payments (-0.6% versus -1.21%). Medicare payments per wRVU markedly declined for TKA (-0.83%), THA (-0.80%), TSA (-0.75%), and ACDF (-1.10%), whereas commercial payments per wRVU for those surgeries showed no notable change. For PLF, there was a notable decrease in both Medicare (-0.63%) and commercial (-1.21%) payments per wRVU.
Over the past decade, both commercial and Medicare surgeon payments for commonly performed inpatient orthopaedic surgeries decreased markedly, with Medicare payments decreasing an average of 1.5 times faster than commercial payments. The impact of declining reimbursements on access and quality of care merits additional investigation.
本研究旨在比较医疗保险与商业支付者对住院骨科手术（全膝关节置换术、全髋关节置换术、全肩关节置换术、前路颈椎间盘切除术和融合术以及后路腰椎融合术）的外科医生专业费用报销和趋势。
在商业保险索赔数据库中查询了 2010 年至 2018 年期间接受全膝关节置换术、全髋关节置换术、全肩关节置换术、单节段前路颈椎间盘切除术和融合术以及单节段后路腰椎融合术的患者。从医疗保险医师费用表中获得每个程序的医疗保险报销和工作相对价值单位 (wRVU)。所有成本均按通胀进行调整，并以 2018 年的实际美元报告。计算复合年增长率以评估每个程序的平均增长率。进行线性回归以评估趋势。
平均而言，医疗保险的支付额比商业支付者低 57%。从 2010 年到 2018 年，每种手术的医疗保险和商业支付均显著下降（所有手术均 P<0.05）。与经通胀调整的商业支付相比，医疗保险支付对 TKA 的下降速度快 2.1 倍（-2.1%对-1.0%），对 THA 的下降速度快 2.8 倍（-1.4%对-0.5%），对 TSA 的下降速度快 1.3 倍（-1.0%对-0.8%），对 ACDF 的下降速度快 1.9 倍（-1.1%对-0.6%）。PLF 是唯一一种医疗保险支付下降速度慢于商业支付的手术（-0.6%对-1.21%）。TKA（-0.83%）、THA（-0.80%）、TSA（-0.75%）和 ACDF（-1.10%）的每 wRVU 医疗保险支付显著下降，而这些手术的每 wRVU 商业支付则没有明显变化。对于 PLF，医疗保险（-0.63%）和商业（-1.21%）的每 wRVU 支付均有明显下降。
在过去十年中，商业和医疗保险支付者对常见住院骨科手术的外科医生支付均大幅下降，医疗保险支付的下降速度平均比商业支付快 1.5 倍。报销下降对医疗服务的可及性和质量的影响值得进一步研究。
