Journal of Orthopaedic Business

No Exceptions: Inflation-Adjusted Medicare Reimbursement Fell for Every High-Volume Orthopaedic Procedure from 2013 to 2023

Tue, 01 Sep 2026 00:00:00 +0000

Introduction: Medicare is the largest federal health insurance program, covering more than 66 million beneficiaries. Reimbursement rates can affect patient access to care. We hypothesized a decline in reimbursement rates for the 20 most frequently billed orthopaedic procedures from 2013 to 2023.

Methods: The top 20 orthopaedic CPT codes were extracted from CMS data. Medicare professional payments were extracted from the CMS Physician Fee Schedule (PFS) and adjusted for inflation. Annual trends in reimbursement rates were analyzed.

Results: All procedures showed declining reimbursement rates from 2013 to 2023 (p < 0.0001). The mean annual decline was $26.26, and reimbursement ranges fell from $231–$2,321 in 2013 to $173–$1,771 in 2023. All CAGR values were negative, indicating consistent annual declines.

Conclusions: Inflation-adjusted Medicare reimbursement rates for high-volume orthopaedic procedures have consistently declined from 2013 to 2023. These findings raise questions about implications for economic barriers to patient access, hospital financial stability, and academic practice viability. Future investigations should compare Medicare and private insurance rates and evaluate procedure utilization rates, in order to help determine whether declining economic trends reduce access to orthopaedic care for older patients.

Level of Evidence: Level III; Retrospective Longitudinal Economic Analysis

Keywords: Medicare; reimbursement; orthopaedic surgery; physician fee schedule; inflation; Current Procedural Terminology; healthcare economics; patient access

Orthopedic Trauma Surgeons Achieve Shorter Operative Times and Lower Implant and Supply Costs Without Compromising Outcomes in Distal Radius ORIF at a Physician-Owned Ambulatory Surgery Center

Tue, 01 Sep 2026 00:00:00 +0000

Objectives: As orthopedic care becomes increasingly specialized, the allocation of wrist fracture treatment must consider value-based care models. Depending on referral patterns, distal radius fractures are treated by trauma or hand fellowship trained physicians. Our objective is to compare operative time and direct costs between orthopedic trauma and hand fellowship-trained surgeons performing distal radius open reduction and internal fixation (ORIF) at a physician-owned ambulatory surgery center (ASC). Complication data were collected to enable clinical outcome comparison.

Design: Retrospective economic and clinical chart review.

Setting: Physician-owned ASC.

Patients/Participants: 411 patients underwent distal radius ORIF from January 2020 to September 2025.

Intervention: Distal radius ORIF stratified by surgeon fellowship training (hand versus orthopedic trauma).

Main Outcome Measurements: Primary: operative time (minutes) and total direct costs (implant and supply costs, USD). Secondary: nonunion, tendon rupture, unplanned hardware removal, and complex regional pain syndrome (CRPS).

Results: Trauma surgeons had significantly shorter operative times (median 36.5 min, interquartile range [IQR] 27.0–46.1) versus hand surgeons (43.5 min, IQR 33.0–63.3; p<0.001) and lower total costs (median $1,011 [IQR $845–$1,386] vs $2,347 [IQR $1,496–$2,782]; p<0.001). Complication rates were equivalent between groups (all p>0.05).

Conclusions: Orthopedic trauma surgeons perform distal radius ORIF faster and at lower cost than hand surgeons without any difference in complication rates. This finding has significant implications for improved contribution margin, lost opportunity cost, value-based care and ASC efficiency.

Level of Evidence: Level III – Retrospective Comparative Study

Key Words: Distal Radius Fractures; Cost Analysis; Fellowship Training; Operative Efficiency; Value-Based Care

Single-Stage Revision Anterior Cruciate Ligament Reconstruction Requires Significantly Longer Operative Time Than Primary Reconstruction, Despite Comparable Reimbursement: A Single-Center Study

Tue, 01 Sep 2026 00:00:00 +0000

Objectives: To evaluate labor and time investment for revision ACL-R procedures, assess billing versus reimbursement disparities, and compare value returned, controlling for time and relative value units (RVUs), between revision and primary ACL-R procedures.

Design: Retrospective cohort study

Setting: Academic Private Practice

Patients/Participants: Patients who underwent primary ACL-R and single-stage revision ACL-R at a single academic institution from 2010 to 2021.

Intervention: Primary ACL-R and single-stage revision ACL-R

Main Outcome Measures: Patient demographics, operative variables, CPT codes, RVUs, billed charges, and final reimbursements were collected and compared between groups.

Results: Of 57 patients, 42 (73.7%) underwent primary ACL-R and 15 (26.3%) underwent revision ACL-R. Revision procedures had significantly longer operative times (159.7±62.4 vs 111.6±32.2 minutes, p<0.001). Revision procedures generated numerically higher RVUs (49.5±13.3 vs 44.1±12.7, p=0.14) and similar RVU efficiency per minute (0.4±0.2 vs 0.4±0.1, p=0.192). Reimbursement per operative minute was numerically lower for revision procedures ($18.5±$10.1 vs $24.9±$16.2), but the difference was not statistically significant (p=0.143). Total reimbursement was comparable between groups ($2,671.4 vs $2,689.1, p=0.972).

Conclusion: Single-stage revision ACL-R required approximately 43% longer operative time than primary procedures (p<0.001) yet generated comparable total reimbursement. Although reimbursement per operative minute was numerically lower for revision procedures, this difference did not reach statistical significance in this small revision cohort (n=15). These findings suggest that a shared CPT code may not fully capture the added time and complexity of revision procedures.

Key Terms: relative value units, RVU, revision anterior cruciate ligament reconstruction, revision ACL-R, operative time, CPT, ACL reconstruction, revision, reimbursement, healthcare economics