Regional Trends in Total Ankle Arthroplasty: A Medicare Analysis of Volume, Reimbursement, and Patient Demographics from 2013 to 2022.

Abstract

Over the past decade, there has been a notable increase in the incidence of total ankle arthroplasty (TAA). The primary purpose of the study was to evaluate regional differences in TAA volume, reimbursement, and patient demographics within the Medicare population from 2013 to 2022. The Medicare Physician and Other Practitioners database was used to identify all instances of primary TAA (CPT 27702). Procedure volume, inflation-adjusted reimbursement, and patient demographics were collected for analysis. Data were regionally sorted based on US Census guidelines. Continuous variables were analyzed using two sample t-tests, and regional differences were evaluated using Kruskal-Wallis tests. From 2013 to 2022, TAA volume increased by 202.9% nationally. The largest increase was in the Northeast (+439.6%) while the smallest increase was in the Midwest (+74.7%). Inflation-adjusted TAA reimbursement declined by 13% nationally, with the Midwest experiencing the greatest decline (-24%), and the Northeast seeing a slight increase (+4%). In 2022, the TAA volume of services per 10,000 beneficiaries was greatest in the South (3.22/10,000) and lowest in the Midwest (1.21/10,000). Reimbursements varied per region, with lowest in the South ($625) and highest in the West ($782). The number of Medicare beneficiaries per TAA surgeon increased by 24% nationally and the average number of billable services per beneficiary increased by 25%. Surgeons in the Northeast performed the most billable services per beneficiary in 2022 (5.4). The average comorbidity burden of patients decreased by 3% during the study period. The rising volume of TAA services has been accompanied by declining reimbursement rates in recent years. Surgeons are treating healthier patients overall and performing more services per beneficiary, reflecting potential pressures of billing practices and raising concerns about access for more complex patients. These patterns highlight potential challenges in maintaining long-term equitable access to TAA for Medicare beneficiaries. Retrospective Cohort Study; IV.