Medicare Reimbursement Trends for Total Joint Arthroplasty: What Does the Future Hold?

Abstract

Research Question: Is Medicare total joint arthroplasty at risk financial unsustainability due to falling reimbursement rates now and in the future?

Background and Significance: While multiple studies have assessed the trends of Medicare reimbursement for orthopaedic total joint arthroplasty(TJA) surgeries, none have forecasted reimbursement in relatable per-hour figures. The purposes of this study are to examine trends of reimbursement for primary and revision TJA and translate forecasted primary TJA reimbursement to relatable per- hour compensation.

Materials and Methods: The Center for Medicare and Medicaid Services(CMS) reimbursement data from 1992-2024 was used to create a historical view of reimbursement for primary and revision TJA. All monetary values were converted to 2023 USD to account for inflation. Polynomial and linear forecast equations were used to predict the future of the TJA reimbursement to 2030. Relative Value Scale Update Committee (RUC) standard times for procedures were used with the forecasts to establish per-hour rates.

Results: Total reimbursement for primary total hip arthroplasty(pTHA)/total knee arthroplasty (pTKA) is forecasted to decrease 85.36%/86.14% by 2030. Using prior trends in reimbursement, TJA procedures are predicted to reimburse at or less than $100.00 2023 USD per Medicare case by 2030. Moreover, TJA surgeons are forecasted to earn $13.93/hr per-pTHA and $14.97/hr per- pTKA by 2030.

Conclusion: This study highlights the concerning trends for both primary and revision arthroplasties as TJA surgeons are on a path to earn below minimum wage for primary TJAs by 2030. Mathematical models forecast a bleak future for orthopaedic TJA reimbursement. This downward trajectory poses risk to access and quality of care.