Henderson Adam P, Moore M Lane, Barron Drew W, Van Schuyver Paul R, Brinkman Joseph C, Haglin Jack M, Chhabra Anikar
Mayo Clinic Alix School of Medicine, Jacksonville, Florida, U.S.A..
Mayo Clinic Department of Orthopedic Surgery, Phoenix, Arizona, U.S.A.
Arthroscopy. 2025 Jul;41(7):2533-2541.e1. doi: 10.1016/j.arthro.2024.11.065. Epub 2024 Nov 22.
To compare Medicaid and Medicare rates for the 20 most commonly billed orthopaedic sports medicine procedures.
Medicaid reimbursement rates were obtained from state-specific fee schedules. Medicare rates were collected from the Centers for Medicare & Medicaid Services Physician Fee Schedule, along with relative value units for each procedure. State rates were compared using averages and dollar differences. Reimbursement rates were adjusted for cost of living using the Medicare Wage Index. Variability between states and between procedures was assessed using coefficients of variation.
Mean Medicaid reimbursement was lower than that of Medicare for 19 of the 20 procedures. In total, Medicaid reimbursed surgeons 14.9% less when data were unadjusted and 26.0% less when data were adjusted for cost of living. Variation in Medicare rates between states was constant, with a coefficient of variation of 0.06. For Medicaid, the coefficients of variation ranged from 0.27 to 0.70 for unadjusted data and from 0.35 to 0.69 for adjusted data.
On average, Medicaid reimburses orthopaedic sports medicine specialists less than does Medicare, with substantial variability between states. Adjustment for cost of living increases the percentage difference and the variability between states' Medicaid reimbursement rates.
Level IV, economic analysis.
比较20种最常见的骨科运动医学手术的医疗补助计划（Medicaid）和医疗保险计划（Medicare）的报销费率。
医疗补助计划的报销费率从各州特定的费用表中获取。医疗保险计划的费率从医疗保险和医疗补助服务中心的医师费用表中收集，同时获取每个手术的相对价值单位。使用平均值和美元差异比较各州的费率。使用医疗保险工资指数对报销费率进行生活成本调整。使用变异系数评估各州之间以及不同手术之间的差异。
20种手术中有19种的医疗补助计划平均报销金额低于医疗保险计划。总体而言，在未调整数据时，医疗补助计划向外科医生的报销金额少14.9%，在对数据进行生活成本调整后少26.0%。医疗保险计划在各州之间的费率差异是恒定的，变异系数为0.06。对于医疗补助计划，未调整数据时变异系数在0.27至0.70之间，调整数据时在0.35至0.69之间。
平均而言，医疗补助计划向骨科运动医学专家的报销金额低于医疗保险计划，各州之间存在显著差异。生活成本调整增加了百分比差异以及各州医疗补助计划报销费率之间的差异。
IV级，经济分析。
