Texas Geographic Trends in Medicare Reimbursement Rates for Primary and Revision Total Knee Arthroplasty: A 20-Year Analysis
DOI:
https://doi.org/10.55576/job.v3i4.45Keywords:
GPCI, Geographic Practice Cost Indices, Facility Price, FP, Reimbursement, Art, ARTHROPLASTY, TKA, Total Knee ArthroplastyAbstract
Objective: The study analyzed Medicare reimbursement trends for primary and revision total knee arthroplasties (TKAs) in Texas's Medicare Administrative Contractor (MAC), a conservative region.
Design: A retrospective review of the Physician Fee Schedule from Centers for Medicare & Medicaid Services (CMS) between 2000 and 2019
Setting: Eight specific localities within the Texas MAC
Patient/Participants: Not applicable; the study involves data, not direct patient participation.
Intervention: Not applicable; the study involved analysis, not intervention impacts.
Main Outcomes Measurement: The average facility price (FP) for primary and revision TKAs was calculated and adjusted for inflation. Linear regression and standard deviation of four components (primary and revision TKA FPs, and their adjusted counterparts) were computed. Mean FP for each locality was determined and compared to median rent for the associated county.
Results : Findings showed steep decreases in reimbursement for all values, with the exception of the average for non-adjusted revision TKA FPs (2.44%). The steepest decline was adjusted primary TKA FP at a downward rate of 42.8% and the reimbursement was incongruent with the cost of living in these areas.
Conclusion: Findings underscore significant reductions in all areas, except non-adjusted revision TKA FPs, and emphasize that reimbursement is not congruent with cost of living. The results demonstrate the indiscriminate reduction in reimbursement rate within a traditionally fiscally conservative area regardless of cost of living, and open the door for further analysis of the effect of geographic practice cost indices on Medicare reimbursement.
Level of Evidence: III, retrospective comparative study.
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