Declining Medicare Work Relative Value Unit Reimbursement in Orthopaedic Surgery: A Cross-Specialty Analysis from 2000 to 2025, with Projections to 2030.

Abstract

Inflation-adjusted Medicare reimbursement has declined over the past 2 decades, raising concerns about the sustainability of procedural practice and patient access to care. Prior trend analyses are often limited to single specialties or use aggregate payments, which can obscure changes in the valuation of surgeon work. We sought to assess reimbursement trends of orthopaedic surgery and compare with other surgical specialties, using work Relative Value Units (wRVUs). Using the Centers for Medicare & Medicaid Services Physician Fee Schedule and the Medicare Physician & Other Practitioners by Provider and Service data set, we identified 10 of the most performed procedures in 2023 for orthopaedic surgery, neurosurgery, general surgery, and urology. Reimbursement was calculated from wRVUs using annual conversion factors, inflation-adjusted to January 2025 US dollars, and evaluated from 2000 to 2025 with projections to 2030. Orthopaedic surgery demonstrated the greatest absolute reimbursement decline, decreasing an average of $526.47 per procedure (50.27%). The remaining declines were $454.14 (52.31%, neurosurgery), $298.94 (46.47%, general surgery), and $242.47 (52.01%, urology), with negative compound annual growth rates across all fields. Projections suggest continued decline through 2030, with General Surgery and orthopaedic surgery exhibiting the largest projected proportional reduction (65.46% and 64.67%, respectively) but orthopaedic surgery demonstrating the greatest projected absolute reimbursement decline by 2030, exceeding $150 per procedure. The valuation of surgeon work has eroded broadly across procedural medicine with orthopaedic surgery experiencing the worst reimbursement reductions, emphasizing the need for collaboration and advocacy among surgical proceduralists. These system-wide trends raise concerns about workforce sustainability, access to complex surgical care, and the effectiveness of specialty specific advocacy efforts to reimbursement policy. Level IV, economic. See Instructions for Authors for a complete description of levels of evidence.