Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
J Shoulder Elbow Surg. 2022 Sep;31(9):1840-1845. doi: 10.1016/j.jse.2022.02.034. Epub 2022 Apr 6.
Shoulder arthroplasty has grown in popularity in the past 2 decades, especially following US Food and Drug Administration approval of reverse total shoulder arthroplasty (TSA) in 2003. Studies have shown that Medicare reimbursement for a variety of orthopedic procedures has decreased significantly over the past 2 decades. No study has evaluated this trend in the setting of shoulder arthroplasty, however. The purpose of this study was to assess true reimbursement trends in primary and revision shoulder arthroplasty since 2000.
Information was collected from the publicly available Medicare Part B National Summary Data Files for the period of 2000 to 2019. Data from Current Procedural Terminology codes 23470 (shoulder hemiarthroplasty), 23472 (TSA), 23473 (single-component revision shoulder arthroplasty), and 23474 (both-component revision shoulder arthroplasty) were analyzed. Reimbursement amounts were adjusted for inflation to May 2021 dollars.
From 2000 to 2019, the number of shoulder hemiarthroplasty procedures billed to Medicare decreased 70% (from 5847 to 1750) whereas the number of TSA procedures increased 1527% (from 4044 to 65,477). During the same period, per-procedure Medicare reimbursement for hemiarthroplasty decreased 35% (from $1545.71 to $1003.43) after adjustment for inflation to 2021 dollars. Similarly, TSA reimbursement decreased 22% (from $1600.98 to $1248.76) after adjustment for inflation. For revision procedures, the number of single- and both-component revisions billed to Medicare increased 381% (from 344 to 1655) and 1331% (from 220 to 3147), respectively. Adjusted reimbursement per procedure decreased 36% (from $1931.62 to $1244.49) and 37% (from $2293.08 to $1449.43), respectively.
This study shows an increase in the annual volume of primary and revision shoulder arthroplasty procedures from 2000 to 2019. During the same period (2000-2019), true Medicare reimbursement to physicians for TSA decreased when adjusted for inflation. This study provides data that may be useful for surgeons, hospitals, and policy makers to maintain access to quality shoulder arthroplasty care moving forward.
肩部关节置换术在过去的 20 年中越来越受欢迎，尤其是在美国食品和药物管理局于 2003 年批准反向全肩关节置换术后。研究表明，过去 20 年来，各种骨科手术的医疗保险报销金额大幅下降。然而，目前还没有研究评估这一趋势在肩部关节置换术中的情况。本研究旨在评估自 2000 年以来初次和翻修肩部关节置换术的实际报销趋势。
从 2000 年至 2019 年，从公共可用的医疗保险 B 部分国家汇总数据文件中收集信息。分析了 23470 号（肩部半关节置换术）、23472 号（反向全肩关节置换术）、23473 号（单组件翻修肩部关节置换术）和 23474 号（双组件翻修肩部关节置换术）的现行程序术语代码数据。报销金额按 2021 年 5 月的通胀进行调整。
从 2000 年到 2019 年，向医疗保险报销的肩部半关节置换术数量减少了 70%（从 5847 例减少到 1750 例），而反向全肩关节置换术的数量增加了 1527%（从 4044 例增加到 65477 例）。在此期间，经通胀调整后，2021 年每例半关节置换术的医疗保险报销金额减少了 35%（从 1545.71 美元降至 1003.43 美元）。同样，经通胀调整后，反向全肩关节置换术的报销金额减少了 22%（从 1600.98 美元降至 1248.76 美元）。对于翻修手术，向医疗保险报销的单组件和双组件翻修手术数量分别增加了 381%（从 344 例增加到 1655 例）和 1331%（从 220 例增加到 3147 例）。每例手术的调整后报销金额分别下降了 36%（从 1931.62 美元降至 1244.49 美元）和 37%（从 2293.08 美元降至 1449.43 美元）。
本研究表明，从 2000 年到 2019 年，初次和翻修肩部关节置换术的年度数量有所增加。在此期间（2000-2019 年），经通胀调整后，医师接受反向全肩关节置换术的实际医疗保险报销金额减少。本研究提供的数据可能对医生、医院和政策制定者在未来维持高质量肩部关节置换术治疗的可及性有用。
