Evaluation and Management-Focused Medicare Billing Threatens Orthopaedic Practice Sustainability and Equitable Access
Forthcoming in Journal of Bone and Joint Surgery.
The US government established Medicare in 1965 through The Centers for Medicare and Medicaid Services (CMS) with the principal purpose of providing national health coverage and financial security for America’s vulnerable population over age 65 not well covered by already established employment-linked plans. In 2022, 58.6 million individuals received medical insurance through Medicare, with 28.4 million of those beneficiaries enrolled in Medicare Advantage plans. As our population continues to age, a substantial portion of the population, will increasingly rely on this coverage to access hospital and healthcare-related services. Unfortunately, financial pressures continue to stack against providers, especially proceduralists who care for larger Medicare populations. In the setting of pre-existing human capital strain after the Covid-19 pandemic, 50-year high inflation rates and increasing administrative costs associated with surgical practice, orthopaedic surgeons are among the most negatively affected by the recent changes announced in the CMS 2023 Final Rule.8