JBJS | Medicare Part B: Physician Participation Options

The Journal of Bone & Joint Surgery, Volume 90, Issue 10

The Orthopaedic Forum | October 01, 2008

Medicare Part B: Physician Participation Options

Sanaz Hariri, MD¹; Kevin J. Bozic, MD, MBA²; Mary I. O'Connor, MD³; Harry E. Rubash, MD⁴

¹ Massachusetts General Hospital, 55 Fruit Street, WHT-5-535, Boston, MA 02114-2696. E-mail address: sanaz@post.harvard.edu
² Department of Orthopaedic Surgery, University of California at San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728. E-mail address: bozick@orthosurg.ucsf.edu
³ Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224. E-mail address: oconnor.mary@mayo.edu
⁴ Massachusetts General Hospital, 55 Fruit Street, YCOC, Suite 3700, Boston, MA 02114-2696. E-mail address: hrubash@partners.org

The Journal of Bone & Joint Surgery. 2008; 90:2282-2291 doi:10.2106/JBJS.H.00562

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Extract

Orthopaedic surgeons in the United States have recently been facing the challenge of caring for their patients in the face of rising costs and declining reimbursements. While medical practice expenses and professional liability insurance rates have been increasing, the average Medicare reimbursement rates for the twenty-five most frequently performed orthopaedic surgical procedures (Table I) have declined 28% since 1992, after adjustment for inflation with use of the Consumer Price Index^1,2. For the last several years, physicians have been subject to what has become a familiar scenario: projected Medicare physician reimbursement decreases are met by last-minute congressional action that either temporarily freezes or marginally increases reimbursement without keeping pace with the inflation rate. None of these congressional stopgap measures revise the formula (the sustained growth rate formula, or SGR) that has mandated, and will continue to mandate, annual decreases in physician reimbursement. Furthermore, since these congressional reimbursement measures escalate Medicare spending beyond the budget mandated by the sustained growth rate formula, the formula will automatically call for even deeper future Medicare budget targets to offset this increased spending.

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Topics

medicare ; medicare part b ; medical coding ; reimbursement mechanisms ; physician payment ; fee schedules

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Accreditation Statement

These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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