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Falling Rates of Public Orthopaedic Surgery Reimbursements and Utilization, 2016 to 2024.
J Am Acad Orthop Surg
January 2025
From the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
Background: Declining reimbursement rates can lead to decreased access and utilization of common orthopaedic surgeries for patients on Medicare, which is a particularly vulnerable population for musculoskeletal injuries.
Methods: Using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool from 2016 to 2024 and utilization data for Medicare and part B beneficiaries from 2016 to 2022, we analyzed reimbursement and utilization trends. Simple linear regressions were executed to measure the annual trends, and Wilcoxon matched-pairs signed rank test were used to analyze the statistical significance of price and utilization changes.
Background: The Centers for Medicare and Medicaid Services (CMS) New Technology Add-on Payment (NTAP) program supports adoption of new, costly medical technologies demonstrating substantial clinical improvement. In 2021, CMS waived the "substantial clinical improvement" criterion for devices designated under the FDA Breakthrough Devices Program (BDP). This study characterized risk-standardized payments associated with hospitalizations in which Medicare beneficiaries received calcium modification during PCI for acute myocardial infarction (AMI) following the adoption of the Shockwave C Coronary Intravascular Lithotripsy (IVL) Catheter (Shockwave Medical) with BDP designation.
View Article and Find Full Text PDFFinancial Impact of Medicare Payment Reform for E/M Visits on Compensation for Otolaryngologic Procedures in 2023.
Otolaryngol Head Neck Surg
January 2025
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
The Centers for Medicare & Medicaid Services (CMS) recently increased payment for evaluation and management (E/M) visits, but did not apply these updates to post-operative global period visits. We investigated the resulting Medicare fee-for-service revenue loss for otolaryngologists. Using publicly available Medicare spending/utilization data, we estimated how much additional payment otolaryngologists would have received in 2023 if CMS had reimbursed global period visits at the same rates as other E/M visits.
View Article and Find Full Text PDFTrends in Neurosurgeons Signing Medicare Opt-Out Affidavits.
World Neurosurg
January 2025
Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Objective: In recent decades, many physicians have chosen to opt out of Medicare, allowing them to set their own pricing models for their patients. Characterization of Medicare opt-outs has not been thoroughly studied in any surgical specialty, including Neurosurgery. Our study characterizes the factors that may influence a neurosurgeon's decision to opt out of Medicare acceptance and contextualizes them both within the field and across various surgical specialties.
View Article and Find Full Text PDFAuthors' Reply to Letter Regarding "Association of Organ Procurement Organization Volume with CMS Performance Evaluations".
Am J Transplant
January 2025
Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Colorado Center for Transplantation Care (CCTCARE), Research and Education, Division of Transplant Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address:
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