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Review
. 2017 Jun;10(2):224-232.
doi: 10.1007/s12178-017-9406-7.

Medicare reimbursement and orthopedic surgery: past, present, and future

R Carter Clement  1 , Suneel B Bhat  1 , Meredith E Clement  1 , James C Krieg  2
Affiliations
Review

Medicare reimbursement and orthopedic surgery: past, present, and future

R Carter Clement et al. Curr Rev Musculoskelet Med. 2017 Jun.

Abstract

Purpose of review: This paper reviews the history and structure of Medicare reimbursement with a focus on aspects relevant to the field of orthopedic surgery. Namely, this includes Parts A and B, with particular attention paid to the origins of Diagnosis Related Groups (DRG) and the physician fee schedule, respectively. We then review newer policies affecting orthopedic surgeons.

Recent findings: Recent Medicare reforms relevant to our field include readmission penalties, the evolution of bundled payments including the mandatory Comprehensive Care for Joint Replacement (CJR) and Surgical Hip and Femur Fracture Treatment (SHFFT) programs, and the new mandatory Merit-based Incentive Payment System (MIPS) pay-for-performance program. Providers are facing an increasingly complex payment system and are required to assume growing levels of financial risk. Physicians and practices who prepare for these changes will likely fare best and may even benefit.

Keywords: Bundled payments; Healthcare reform; Medicare; Merit-based incentive payment system (MIPS); Orthopedic surgery; Reimbursement.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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