Recent Trends in Utilization and Medicare Physician Reimbursement for Total Ankle Replacement (TAR) and Ankle Arthrodesis (AA) from 2010-2021

Category: Ankle; Trauma Introduction/Purpose: There has been limited investigation into physician reimbursement trends in foot and ankle procedures. The objective of the present study is to query a large, national insurance claims database to assess how utilization and reimbursement has evolved for ankle arthrodesis (AA) and total ankle arthroplasty (TAR) procedures from 2010 to 2021. Methods: A large national insurance claims database was queried for ankle arthrodesis and total ankle arthroplasty from 2010 to 2021 using Current Procedural Terminology (CPT) codes. Utilization rates, hospital reimbursement rates by payor (commercial, Medicare, Medicaid, Government, cash, other) and demographic data including gender, age, region, payor type, and service location were extracted. Subsequently, physician Medicare reimbursement rates were obtained from 2010 to 2021 using the Physician Fee Look-up Tool from the Centers for Medicare and Medicaid Services. Dollar values were then adjusted using the Consumer Price Index and are reported in 2023 US dollars. Trend analysis of utilization and reimbursement rates was then performed, with a p value of < 0.05 as significant. Results: A total of 16833 TAR patients and 33109 AA patients were identified by the query. Both procedures demonstrated a significantly positive linear trend in volume over the included time period, with increase from 2010 to 2021 of 30.28% (2453 to 3196 patients; p< 0.001) for AA cases and 140.64% for TAR (994 to 2392 patients; p< 0.001). Without consideration of inflation, Medicare physician reimbursement values were stable, demonstrating a non-significant increase for both AA (+2.67%) and TAR (+3.40%) over the included time period. On the other hand, after accounting for inflation, values declined across both AA and TA, with decrease from 2010 to 2021 of 16.78% ($1194.24 to $993.81; p< 0.001) for TAR procedures and 17.37% ($1368.26 to $1130.62) for AA procedures (Figure 1). Conclusion: Despite the growing number of Medicare beneficiaries and utilization of TAR and AA, the present data has demonstrated a decrease in Medicare reimbursement. Knowledge of such trends is important for the orthopedic field in order to advocate for sustainable reimbursement that supports the consistent delivery of high-quality patient care.