Reimbursement for orthopedic care differs between hospital outpatient departments and ASCs, and payer types also play a factor, according to a study published in Journal of Market Access and Health Policy.
Six things to know:
1. The study analyzed 32 high-volume CPT codes in cardiology, gastroenterology, orthopedics and urology.
2. Across all specialties, HOPD reimbursement ranged from 124% to 861% of ASC/office rates for Medicare and 111% to 1,346% for commercial payers.
3. For total knee replacement (CPT code 27447), HOPD reimbursement from Medicare was $13,837 compared to $10,339 in an ASC.
4. Reimbursement for total knee replacements by commercial payers in HOPDs was $28,347 in comparison to $21,771 in an ASC.
5. Between 2001 and 2021, facility fees grew 60% (2.4% year-over-year) compared to 11% growth (0.5% year-over-year) for professional fees.
6. As of 2022, 41% to 52% of physicians were hospital-affiliated, 23% corporate-affiliated and less than 4% worked in PE-backed management services organizations.
