Medicaid reimbursements for orthopedic procedures vary greatly across the US: 3 insights

Written by Shayna Korol | February 08, 2018 | Print  |

There is substantial variation between states in Medicaid reimbursements for common inpatient orthopedic procedures, according to a study in The Journal of Bone & Joint Surgery.

Here are three things to know:


1. The study authors identified the 10 most commonly performed inpatient orthopedic procedures as ranked by the Healthcare Cost and Utilization Project National Inpatient Sample.


2. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts by ratio, dollar difference and dollar difference divided by the relative value unit amount. Variability was determined by identifying the range and coefficient of variation for those reimbursement amounts.


3. For all 10 procedures, the range of Medicaid reimbursement variability among states exceeded $1,500. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from −$8/RVU for total knee arthroplasty to −$17/RVU for open reduction and internal fixation of the femur. This variation is notable in light of shifts towards focusing reimbursements on value.


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