“It’s a zero-sum game,” says one concerned joint surgeon regarding the actions by the Relative Value Scale Update Committee (RUC). “Under the guise of controlling costs, they are contemplating shifting reimbursement away from total joint surgeons and giving it to other parties who don’t perform procedures. Specifically, it’s like the internists are ganging up on orthopedic surgeons. The RVU system promotes uncomfortable choices and competition among medical service providers.”
“This committee administers the value assigned to certain work done with Medicare patients (Relative Value Units) and equates that work to a financial reimbursement amount. In the current environment, the codes for TJR are being proposed for decrease and those for Evaluation and Management visits (cognitive-based care where patients visit with a physician) are proposed for increase. In the early 90s when Medicare reimbursement went away from fee for service without constraint and adopted the RVU system, the limitations on the CMS budget were not well predicted.”
“When you adjust the Relative Value Scale it doesn’t save money…it’s just a ‘Lord of the Flies’ situation. Increased reimbursement for one code must be offset by a decrease in another code. There was a recent article on how joint codes are overvalued because surgeons now take less operative time than they did previously. While the latter part is true, it is also the case that the cost of the episode of joint replacement has been reduced from $30,000 plus per episode to $20,000 or less per episode—with increased quality and decreased cost. The surgeon’s reimbursement has little to do with this episode savings. Surgeons now spend more time with patient optimization prior to surgery, patient education, digital and non-digital communication, and detailed post discharge management in order to improve outcomes.
“The current surgeon Medicare TJR reimbursement is approximately $1200—although most people think surgeons are making $5,000-$10,000 per case (that would only be in, say, the New York fee for service environment). I’m telling you right now that if the reimbursement falls below $1,000 for Medicare TJA surgery then some surgeons will stop doing total joint surgeries for Medicare patients. This is especially true for difficult, complex, high risk cases which are not reimbursed at a higher rate and have increased risks of complications.”