Objectives: Trends in reimbursement continue to affect how healthcare is practiced. Few studies have compared this to the clinical value across a variety of procedures. Our objective was twofold: Is Sports Medicine reimbursement staying the same or decreasing over time for common procedures? Does this correlate with their clinical efficacy? Methods: From 2013-2021, the Medicare database (Medicare Physician and was queried to evaluate for the codes: 29827 (Rotator Cuff Repair), 29826 (Subacromial Decompression), 23472 (Total Shoulder Arthroplasty), 29881 (Meniscectomy medial or lateral), 29880 (Meniscectomy medial and lateral), and 29877 (Chondroplasty Knee). We proceeded to calculate the average reimbursement per year and the number of each procedure performed annually via the Medicare database. We also utilized the American Institute of Economic Research inflation calculator to convert previous years dollar value amount to 2021 dollars based on inflation for more accurate analysis. Results: Medicare reimbursement did not remain consistent with inflation over the period 2013-2021. Shoulder arthroplasty increased dramatically from 32, 208 to 71, 794 procedures performed, which is more than double the volume. The average Medicare compensation has decreased from 836 to 781 for shoulder arthroplasty (7% decrease in reimbursement). This does not account for inflation, which in 2021 dollars, represents a 20% decrease from 972 to 781 (Table 1). There has been an even greater decrease in the reimbursement for subacromial decompression. Accounting for inflation, reimbursement decreased from 212 in 2021 dollars to 101, which is a >50% decrease (Table 2). In conjunction with this the volume has decreased from 94, 477 to 58, 880 procedures performed. This is in contrast with rotator cuff repair, for which inflation-adjusted reimbursement has remained relatively similar at a 3% decrease from 2013-2021 (896 vs 926). Whereas the volume of rotator cuff repairs performed have increased by 12% (67, 585 to 76, 784). Over time, there has been a 50% decrease in the volume of meniscectomy. Partial meniscectomy reimbursement has remained relatively constant over the period of this study (-1. 5% for medial or lateral and +0. 5% for medial and lateral partial meniscectomy). In the same period there has been a notable decrease in volume from 53154 to 27119 for cpt code 29881 and 43753 to 22012 for 29880. There has also been a 60% decrease in the volume of chondroplasty (434 to 171), as well as a 30% decrease in reimbursement (from 729 to 512 in 2021 dollars) (Table 3). Conclusions: Sports reimbursement has been decreasing over time relative to inflation, which is very concerning for maintaining the viability of a sports practice. The decline in reimbursement is markedly different between sports procedures and does not appear consistently tied to the clinical efficacy as demonstrated in the literature. Reimbursement has decreased for shoulder arthroplasty. This is interesting because shoulder arthroplasty has expanding indications and volume has increased accordingly, but reimbursement is still decreasing. Rotator cuff repair is also a procedure with increasing volume owing to improved surgical techniques, but reimbursement has stayed the same. There was an over 50% decrease in reimbursement for subacromial decompression consistent with the decreased clinical efficacy as seen in the literature. This is in contrast with partial meniscectomy, where reimbursement stayed relatively the same despite some literature showing decreased clinical efficacy. In summary, reimbursement is decreasing for common sports procedures and is not clearly linked to the relative clinical efficacy of different procedures.
Miller et al. (Mon,) studied this question.