Medicare payments for hip and knee replacements are already tight, and they may get tighter. CMS’ proposed calendar year 2027 Medicare Physician Fee Schedule rule would cut physician payment for total hip and total knee replacements by up to 20%, according to OrthoForum, a group representing physician-owned orthopedic practices. That proposal would stack on top of an 8% cut to joint replacement reimbursement that already took effect in 2026 — even as CMS has proposed payment increases for hospitals and other facilities over the same period.
Jeffrey Geller, MD, is the Nas S. Eftekar professor of orthopedic surgery at Columbia University Irving Medical Center in New York City and chief of orthopedic surgery at NewYork-Presbyterian/Lawrence Hospital. He has performed close to 10,000 joint replacement cases. He said shrinking Medicare payments for hip and knee replacements won’t stay confined to physician paychecks — they’ll reach patient mobility, chronic disease management and the broader health system.
“What we’re seeing nationally is diminishing of private practices, where private practices are being absorbed either by hospitals or, in some cases, insurance companies,” Dr. Geller said.
“This is going to further drive that process because nationally, the reimbursement of a hip or a knee replacement is going to be somewhere in the $900 range per surgery for surgeon reimbursement, which is pretty astonishing. There is really almost no way a surgeon in private practice is going to be able to cover their overhead at all with that sort of level of reimbursement.”
Dr. Geller said that math is already pushing some surgeons toward a choice: drop Medicare patients or limit how many they see.
“What many surgeons are going to have to do is start to either drop out of Medicare because they simply cannot keep their practice open if they do,” he said. Alternatively, Dr. Geller speculated that providers would need to cap the number of Medicare patients they see and potentially place those patients on waitlists, as is done in Canada or the United Kingdom, under their respective government-funded healthcare plans.
“This can’t be looked at in a vacuum,” he said.
Some hospitals may absorb more Medicare joint cases as private practices pull back, but Dr. Geller said CMS quality programs are adding pressure of their own. Bundled-payment models that hold doctors and hospitals responsible for a patient’s full 30-day episode of care, he said, penalize readmissions in ways that can discourage taking on more complex patients.
“What’s also wrapped up in this are some of the other CMS quality projects that are also going on concurrently,” Dr. Geller said. “The Teams program even further disincentivizes practices from taking care of more complicated patients because the hospitals will be penalized. At a certain point, even bigger hospitals are going to say this is a challenging problem, and we may have to ration care a little bit, because this is becoming a financial liability for even larger hospital systems.”
Dr. Geller pointed to another disconnect: Surgeon fees make up only about 6% to 10% of the total cost of a joint replacement, yet CMS’ proposed rule would cut physician payment while raising facility payments over the same period.
“There’s a lot of politics behind a lot of that, and doctors are a small part of the whole picture,” he said. “The voice that we have in this whole situation is a very small voice. What it says to me is that we’re an easier target compared to hospitals. It says to me that the government is likely trying to drive more physician practices and physician groups more towards hospital-based groups, and slowly but surely remove independent practices and private practices on their own — and it’s giving hospitals more and more influence over the whole medical ecosystem.”
If the cuts hold, Dr. Geller expects longer waits and a shift in who performs the more complicated cases, as experienced surgeons drop out of Medicare and junior colleagues absorb higher-risk patients.
For Dr. Geller, the stakes are easiest to see outside the operating room. He said he recently played a round of golf with an 85-year-old partner who was “parring every hole” and looked decades younger than his age. When Dr. Geller mentioned his specialty, the player told him he never could have been on the course that day “if I hadn’t had my knee replaced.”
Dr. Geller said this golfer, along with the majority of seniors, would not have been able to pay out of pocket for the surgery or for private insurance to cover it.
That kind of outcome, Dr. Geller said, is what’s at risk if reimbursement keeps falling and access narrows.
“I would urge the decision makers to not look at the bigger number — which is, hip and knee replacement surgeries are probably the No. 1 line item for CMS in terms of the overall cost of care — but look at the ripple effect that it’s going to have on decreasing the mobility as well as the overall health status of many of our seniors in this country,” Dr. Geller said.
“The cardiac, the diabetic endocrine, osteoporosis, blood pressure — all of the medical byproducts of significant decrease in mobility of our seniors,” he said. “That, in the long run, I believe, is going to massively drive up the cost of medical care in this country if this measure is passed by CMS.”
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