November 07, 2016
2 min read

Patients overestimated physician Medicare reimbursement for meniscectomy, ACL reconstruction

Patients predicted fees to be substantially higher than actual reimbursement.

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Patients believed Medicare reimbursements for physicians were substantially higher for arthroscopic meniscectomy and ACL reconstruction in comparison with actual reimbursements, according to a study.

“There is a common perception that surgeons are paid large amounts of money per procedure they perform. Our study found that what patients perceive surgeons are paid for two common sports procedures is substantially larger than actual Medicare reimbursement,” Kelechi R. Okoroha, MD, resident physician and surgeon at Henry Ford Hospital, told Orthopedics Today.

Surgeon reimbursement

Okoroha and his colleagues provided surveys to 231 consecutive patients (53% women) that asked how much they believed a surgeon should be reimbursed for performing an arthroscopic meniscectomy or ACL reconstruction. The surveys also asked patients for their perception of actual Medicare reimbursement to physicians. After informing patients of the actual reimbursement rates, researchers then asked patients additional questions about health care reform. Researchers compared survey responses between urban and suburban settings.

Patients perceived a reasonable fee of $8,096 for meniscectomy and $11,794 for ACL reconstruction, approximately 14-times and 11-times more than what is actually reimbursed, respectively. Researchers found patients estimated physicians received a payment of $5,442 for meniscectomy and $6,667 for ACL reconstruction from Medicare. When it came to out-of-pocket payments, patients were willing to pay $2,286 for meniscectomy and $3,517 for ACL reconstruction.

Once patients were informed of the actual reimbursement for both procedures, 65% and 57% of patients believed reimbursement was too low for meniscectomy and ACL reconstruction, respectively. Results showed patients believed a more appropriate value for reimbursement would be $2,719 for meniscectomy and $4,885 for ACL reconstruction.

Health care cost reduction

According to results, 87% of patients did not think surgeons were overpaid; 88% of patients did not think surgeons’ salaries should be cut; and 61% of patients did not think that surgeon salaries should be linked to outcomes. When it came to lowering rising health care costs, Okoroha noted 79% of patients believed reimbursement to drug and device manufacturing companies should be decreased compared with 2% who believed surgeon reimbursement should be decreased.

Overall, 82% of patients believed orthopedic subspecialization was important. In addition, 75% of patients believed orthopedic surgeons should receive extra compensation for the additional training, and, on average, patients believe specialized surgeons should receive an additional compensation of $1,478 per procedure.

“Over the years, Medicare has reduced surgeon reimbursement for orthopedic procedures. These reductions are made without taking into account the physician cost to care for the patient or the patient value in the procedure. There has been a shift in medicine to incorporate patient-based outcomes and patient satisfaction. However, methods of reimbursement do not reflect any patient-based values,” Okoroha said. “Our study adds to the literature by demonstrating how much patients value these procedures. We also learned our patients’ opinions on decreasing health care cost and the importance of surgeon specialization.” – by Casey Tingle

Disclosure: Okoroha reports no relevant financial disclosures.