Declining trends in Medicare physician reimbursements for shoulder surgery from 2002 to 2018

Background: As the current health care system evolves toward cost-containment and value-based approaches, evaluating trends in physician reimbursements will be critical for assessing and ensuring the financial stability of shoulder surgery as a subspecialty.

Methods: The Medicare Physician Fee Schedule Look-up Tool was used to retrieve average reimbursement rates for 39 shoulder surgical procedures (arthroscopy with or without repair, arthroplasty, acromioclavicular or clavicular open reduction-internal fixation, fixation for proximal humeral fracture and/or shoulder dislocation, open rotator cuff repair or tendon release and/or repair, and open shoulder stabilization) from 2002 to 2018. All reimbursement data were adjusted for inflation to 2018 dollars.

Results: After adjusting for inflation to 2018 dollars, average reimbursement for all included procedures decreased by 26.9% from 2002 to 2018. After stratifying the analysis by 3 distinct time groups, we observed that reimbursement decreases were the most significant prior to 2010. However, reimbursement rates still declined by an average of 2.9% from 2010 to 2014 and 7.2% from 2014 to 2018. Arthroscopic rotator cuff repair, capsulorrhaphy, and biceps tenodesis experienced smaller declines in reimbursement than their open-surgery counterparts.

Conclusion: Medicare physician reimbursements for shoulder surgical procedures have decreased over time. Health care policy makers need to understand the impact of decreasing reimbursements to develop agreeable financial policies that will not only ensure provider satisfaction but also maintain access to care for patients.