CMS is proposing to cut physician reimbursement for total hip and knee replacement by approximately 20% in 2027, on top of an 8% reduction that took effect earlier this year.
The proposal would reduce physician payment for both procedures while simultaneously increasing hospital reimbursement 2.3% — a widening gap that could threaten both independent practice viability and Medicare patient access.
Ask Orthopedic Surgeons is a series of questions posed to orthopedic surgeons and leaders around the country about clinical, business and policy issues affecting orthopedic care. Becker’s invites all orthopedic surgeons and specialists to respond.
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Please send responses to Cameron Cortigiano at ccortigiano@beckershealthcare.com by 5 p.m. Central time Oct. 12.
Note: Responses were lightly edited for clarity and length.
Question: How are you preparing for the proposed CMS cuts to hip and knee replacements, and what happens to access if those cuts go through?
Christopher Baker, MD. Orthopedic Surgeon at Florida Orthopedic Institute (Tampa): The 2027 Medicare Physician Fee Schedule Proposed Rule from the Centers for Medicare & Medicaid Services (CMS) outlines about a 20% payment reduction to physicians who perform primary joint arthroplasty. This payment reduction to physicians would include hip, knee, shoulder and other total joint arthroplasty procedures. While at the same time CMS has increased payments to hospitals of 2.3% for acute care after total joint arthroplasty under the Inpatient Prospective Payment System (IPPS). Unfortunately, this is just another cut to physician reimbursement for becoming more productive, efficient and effective at safely and successfully performing outpatient total joint arthroplasty. This shift to safe and effective outpatient arthroplasty is completely driven by physician efforts and has saved the American healthcare system and taxpayers countless dollars.
The proposed fee schedule change will have several effects for orthopedic surgeons. First, and possibly the purpose of such changes, is to further reduce and/or eliminate the private practice of orthopedic surgeons, driving physicians into hospital employment. Second, those physicians who wish to remain in private practice will be forced to make up the lost revenue with increased number or expanded services or continue to reduce overhead in the form of reduced full-time employees, putting more work on those who remain employed. Third, which I am increasingly hearing, is planning to reduce Medicare patient volumes or even potentially opt out of Medicare altogether. This would obviously be bad for our aging and increasing number of Medicare-eligible populations in the U.S. Reduced access to services is clearly the last thing surgeons want. Total joint arthroplasty surgery is one of the most successful and important surgeries in the world regarding success and improved patient quality of life and no country does it better than the U.S.
Our surgeons are working with our colleagues across the country and with our various academies; AMA, AAOS, AAHKS, ASES and many more. We are engaging our members to work with their senatorial and congressional representatives to help them understand how this will affect both physician practices and patient access to care. We are always in a state of improving our efficiencies in private practice. This only solidifies the need for private practice physicians to remain lean and agile to deal with the ever-changing headwinds of the American healthcare system. To do anything other than remain vigilant would certainly mean the end of your practice.
Evalina Burger, MD. Chair of the Department of Orthopedics at the University of Colorado Anschutz (Aurora): Preventing CMS cuts will require coordinated advocacy by professional organizations, surgeons, healthcare professionals and patients. This includes challenging inaccurate payment data and valuation methods, urging Congress to act, submitting formal comments and providing clear evidence that reduced reimbursement could limit staffing and surgical capacity, accelerate practice consolidation and reduce patient choice and access to care. Leaning on our hospital systems to partner with us in providing access to care for our aging populations is more important than ever.
Antonia Chen, MD. Chair of Orthopedics at the UT Southwestern Medical Center (Dallas): My biggest concern about the proposed CMS cuts to hip and knee replacements is that more and more surgeons will have to take fewer Medicare patients or stop taking Medicare patients at all. The amount of money that we are getting for hip and knee replacements may not cover the overhead of taking care of these patients. Access will significantly be reduced if these cuts go through, making the wait times for procedures that provide a high quality of life and ability to improve mobility prolonged, which will not make America healthy again. The wait times could rival those of other countries such as the United Kingdom and Canada.
Jesse Chrastil, MD. Joint Replacement Surgeon at Panorama Orthopedics & Spine Center (Golden, Colo.): I want to care for every Medicare patient who walks through my doors. These patients have paid into the system for decades and deserve the same standard of care as anyone with private insurance, and my own parents are among them. But Medicare reimbursement for total hip and knee replacement has already been slashed by more than 55% between 2005 and 2025, while wages, staffing costs and practice overhead have exploded. It is difficult to justify the disconnect between CMS considering another 20% cut to a payment that has already been substantially reduced and the reality that the cost of delivering care continues to rise. Surgeons should be receiving a meaningful cost-of-living adjustment that reflects what it actually costs to staff, equip and operate a medical practice today, not another reduction that pushes reimbursement even further away from economic reality.
Make no mistake: if these cuts go through, it will be CMS limiting access to care and will not be surgeons limiting access to care. By pushing reimbursement below the cost of providing care, CMS is effectively deciding that Medicare patients will wait longer and have fewer options for the joint replacements they have earned.
Kurt Hirshorn, MD. Orthopedic Surgeon at Florida Orthopedic Institute (Tampa): I am preparing for potential CMS reimbursement cuts by focusing relentlessly on efficiency without compromising the quality or safety of care. As a joint replacement surgeon, I see firsthand the difference that modern hip and knee replacement can make in my patients’ lives. We continue to adopt minimally invasive techniques, standardized clinical pathways and evidence-based protocols that help patients recover more efficiently and return home safely. But there is a limit to how much efficiency can offset reductions in reimbursement. High-quality joint replacement requires highly trained surgeons and staff, advanced technology, appropriate implants, operating-room resources and comprehensive pre- and postoperative care. We have to be very careful that efforts to reduce the cost of care do not inadvertently reduce the quality of care.
My greatest concern with significant CMS cuts is what they could mean for patient access. Medicare patients deserve the same access to highly specialized joint replacement care as everyone else. If reimbursement falls below the cost of providing that care, hospitals and surgeons will ultimately be forced to make difficult decisions about where and how they provide these procedures. The patients most vulnerable to this are often those with more complicated disease or those who require revision surgery — patients who need specialized expertise the most. We should absolutely pursue greater value and eliminate unnecessary costs, but we cannot achieve savings by making it financially unsustainable to provide care. As physicians, our responsibility is to make sure that Medicare patients continue to have timely access to safe, advanced hip and knee replacement when they need it.
Amit Jain, MD. Spine Surgeon and Vice President, Care Transformation at Johns Hopkins Medicine (Baltimore): We are focusing on strict perioperative optimization, migrating eligible cases to outpatient settings and eliminating post-acute discharge variation. If these cuts go through unmitigated, they will force independent and safety-net providers to ration access for complex, high-risk Medicare beneficiaries. This will ultimately hurt Medicare beneficiaries.
Joseph Zuckerman, MD. Chair of the Department of Orthopedic Surgery at NYU Langone Health (New York City): Since we are an RVU-based compensation system the impact would be significant. Options for us include changes to operative cases as a measure of productivity.
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