Medicare Reimbursement Trends for Common Knee Arthroplasty Procedures: A Generational Perspective, 2006 to 2024.

Abstract

The primary aim of this study was to assess the trends in Medicare reimbursement for knee arthroplasty procedures between 2006 and 2024. This study examined payment trends for common knee arthroplasty procedures by analyzing data from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (1) between 2006 and 2024. Medicare reimbursement was determined by multiplying Relative Value Units (RVUs) by the CMS conversion factor, with adjustments made for inflation to 2024 United States (U.S.) dollars using the Consumer Price Index (CPI) (2) inflation calculator provided by the U.S. Department of Labor. Future trend projections were generated based on average values from 2020 to 2024. Between 2006 and 2024, total reimbursements for all knee procedures dropped by 2.7%, while the CPI increased by 55%, leading to an inflation-adjusted average reimbursement drop of 37.2%. Primary total knee arthroplasty had the most significant drop, with reimbursements decreasing by 45.1%. Unadjusted work reimbursements across all procedures decreased by 8.5%, translating to a 40.9% inflation-adjusted reduction. Considering the current trend, projections for 2029 indicate a further projected reduction in total surgeon reimbursement of 18.5 to 54.7%, while work reimbursements could decrease by 23.2 to 63.6%. From 2006 to 2024, there has been a major decline in Medicare reimbursements for knee arthroplasty procedures after adjusting for inflation, raising concerns about the financial sustainability of orthopaedic practices. This trend may pressure healthcare providers to increase patient volumes, potentially leading to burnout and compromised patient care. Reimbursement rates should be adjusted to the value that orthopaedic surgeons provide to patients.