US Orthopaedic Partners, White Plains, NY.
Tuckahoe Orthopaedic Associates, Richmond, VA.
J Arthroplasty. 2021 Oct;36(10):3378-3380. doi: 10.1016/j.arth.2021.05.016. Epub 2021 May 19.
There has been 25-year trend of decreasing value for orthopedic surgical work based on the Resource-Based Relative Value Scale (RBRVS) for Medicare reimbursement. This study was undertaken to estimate the time that Medicare payment rates for time spent in the office doing cognitive work will equal time dedicated in the operating room to performing procedural work based on long-term negative payment trends.
The RBRVS Update Committee database was accessed to extract the time elements for 2 procedures, total knee arthroplasty and total hip arthroplasty (27447 and 27130), on the day of surgery. The evaluation and management code mix for 2 mid-sized orthopedic practice was averaged to create an amalgamated rate for the reimbursement of office work on an hourly rate. A graph of the 25-year trend line in Medicare reimbursement for arthroplasty procedures was used to create a trend line. The trend line was then extrapolated to estimate the time in the future that the hourly rate for office work would equal the hourly rate for surgery.
Time inputs and the Medicare conversion factor for 2021 were used in this analysis. Total procedural time for both 27447 and 27130 was 204 minutes (3.4 hours) on the day of surgery. An amalgamated hourly office rate of 7.9 relative value unit was calculated from the average of the 2 mid-sized private practices for an overall in office Medicare reimbursement of $318.89/h, with $1083.04 for the 3.4 hours allowed in the RBRVS Update Committee database for a joint replacement. When the trend line for reimbursement was extrapolated to the $1083.04 price point, the year corresponding to the point where hourly office reimbursement would equal hourly surgical work was 2024.
Policymakers in Washington and practicing orthopedic surgeons need to consider the looming economic parity of surgical and cognitive work for Medicare. Continued negative reimbursement rates are likely to decrease patient access to necessary surgical care and result in de facto rationing of arthroplasty services for Medicare patients. The deployment of the orthopedic workforce is likely to change to accommodate the decreases in the value of surgical work. This trend will have significant impact on the practice of musculoskeletal medicine and patient access to orthopedic services.
根据医疗保险报销的基于资源的相对价值量表（RBRVS），骨科手术的价值已经呈下降趋势，持续了 25 年。本研究旨在估计，基于长期的负向支付趋势，办公室认知工作的 Medicare 支付率与手术室程序性工作所需时间相等所需的时间。
访问 RBRVS 更新委员会数据库，以提取手术当天 2 种手术（全膝关节置换术和全髋关节置换术）的时间要素（27447 和 27130）。将 2 家中等规模骨科实践的评估和管理代码组合平均化，创建一个按小时计费的办公室工作报销综合费率。使用关节炎手术 Medicare 报销 25 年趋势线图创建趋势线。然后对趋势线进行外推，以估计未来办公室工作的小时费率何时等于手术的小时费率。
本分析使用 2021 年的时间输入和 Medicare 转换系数。手术当天，27447 和 27130 的总手术时间为 204 分钟（3.4 小时）。从 2 家中等规模私营企业的平均值计算出一个综合的 7.9 个相对价值单位的小时办公费率，为整体办公室 Medicare 报销 318.89 美元/小时，在 RBRVS 更新委员会数据库中允许的 3.4 小时内，每个关节置换术可报销 1083.04 美元。当报销趋势线外推到 1083.04 美元的价格点时，对应的小时办公报销等于每小时手术工作的年份是 2024 年。
华盛顿的政策制定者和骨科外科医生需要考虑 Medicare 手术和认知工作即将出现的经济均等化。持续的负向报销率可能会降低患者获得必要手术护理的机会，并导致事实上对 Medicare 患者的关节置换服务进行配给。骨科劳动力的部署可能会发生变化，以适应手术工作价值的下降。这一趋势将对肌肉骨骼医学的实践和患者获得骨科服务的机会产生重大影响。
