SLR - August 2022 - Austin Rollins, DPM
Reference: Pollock JR, Moore ML, Haglin JM, LeBlanc MP, Rosenow CS, Makovicka JL, Deckey DG, Hassebrock JD, Bingham JS, Patel KA. Between 2000 and 2020, Reimbursement for Orthopaedic Foot and Ankle Surgery Decreased by 30. Arthrosc Sports Med Rehabil. 2021 Dec 24;4(2):e553-e558. doi: 10.1016/j.asmr.2021.11.016. PMID: 35494293; PMCID: PMC9042755.Level of Evidence: 4
Scientific Literature Review
Reviewed By: Austin Rollins, DPM
Residency Program: Creighton University – Phoenix, AZ
Podiatric Relevance: There is little research regarding physician insurance reimbursement trends, and is even more rare within the podiatric literature. This is likely due to the stigma that surrounds the financial responsibilities of a medical practice and the altruistic notion that patient care should remain unbiased from financial influence. Some evidence that is available shows that financial incentives to providers can influence the availability patients have to health care, decrease the rate of provider burnout and influence provider likelihood to invest in medical technologies that may benefit patients.
Methods: Analyses of the 20 most used orthopedic foot and ankle surgical CPT codes were gathered. Pricing information was acquired from geographic Medicare administrative contractors for each of the procedure reimbursements. The rate of change of reimbursement of the procedures, both individually and together, were compared to the Consumer Price Index date obtained from the U.S. Department of Labor, Bureau of Labor Statistics. Additionally, an analysis was performed to adjust reimbursement values after adjusting for inflation from the years 2000-2020.
Results: The unadjusted rate of Medicare reimbursement for foot and ankle procedures rose 7.3 percent from 2000-2020. Within that same period the Consumer Price Index rose 52.8 percent. When adjusted for inflation, foot and ankle procedures showed a decrease in reimbursement of 29.8 percent within the stated 20 years. Correction of hallux valgus-bunionectomy, with sesamoidectomy (CPT 28296) had the largest adjusted decrease in reimbursement at 47 percent. The smallest adjusted decrease in reimbursement was noted to be closed treatment of metatarsal fractures (CPT 28296) at 7 percent. The mean reimbursement for the selected CPT codes in 2000 was $579. Adjusting for inflation, the mean 2020 reimbursement was $393. The data was then analyzed in two 10-year periods, 2000-2010 and 2010-2020. The average percent change from 2000-2010 decreased 22.2 percent, 2010-2020 decreased 11.5 percent.
Conclusions: Medicare is not only the largest payer in our health care system, but is also used as a benchmark for all other private and single payor insurance programs. Knowledge of current physician reimbursement trends are essential to promote proper awareness and advocacy efforts. The problem with the current trend noted in this study is further complicated by an increase in costs to run and maintain a medical practice. Demand and need for foot and ankle surgery continues to increase as financial incentives decrease. Ultimately this may negatively affect recruitment of young professionals to both podiatry and foot and ankle trained orthopedic surgeons. The foot and ankle specialty is not the only specialty in this current trend in Medicare reimbursement. This study can be used as a scale to compare similar trends in other subspecialties.