Orthopedic surgeons are bracing for new and proposed policies that could further reduce pay in 2025 and beyond, adding pressure to already shrinking margins.
The changes span both commercial and government payers, from Medicare conversion factor cuts to prior authorization hurdles and rising overhead costs — policies that threaten practice sustainability and patient access.
Surgeons warn the impact goes beyond income, delaying care and accelerating consolidation.
“Prior authorization consumes endless time and phone calls with no guarantee of payment,” Klaud Miller, MD, an orthopedic surgeon and medical director of Windy City Orthopedics and Sports Medicine in Chicago, told Becker’s in November. “It does nothing for the patient or the doctor.”
Here are five things to know:
1. CMS cuts continue: CMS finalized a 2.83% reduction to the physician fee schedule conversion factor for 2025.
“Medicare plans to pay us less while costs go up,” American Medical Association president Bruce Scott, MD, told Becker’s in November 2024, calling the trend unsustainable, especially for rural and independent practices.
2. Prior authorization and prepayment reviews: Orthopedic surgeons continue to face denials and delays. Prepayment reviews add another layer of red tape, with insurers revisiting claims even after procedures are performed — further postponing reimbursement.
3. Inflation outpaces reimbursement: When adjusted for inflation, Medicare physician pay has fallen nearly 29% since 2001. Rising staffing, supply and technology costs are making it harder for orthopedic practices to stay financially viable.
4. Automation and documentation demands grow: To preserve margins, some orthopedic groups are cutting administrative staff, automating workflows and re-educating teams on proper coding and billing strategies.
“As reimbursements diminish and scrutiny of claims goes up, we have been forced to automate our business processes and strategy to maintain a positive cash flow. This has resulted in the elimination of front-office positions, but these adjustments are unfortunately necessary in order to stay in practice,” James Andry, MD, orthopedic surgeon at Disc Surgery Center at Carlsbad (San Diego) told Becker’s in July.
5. Surgeon shortages threaten access: The U.S. faces a projected shortage of more than 5,000 orthopedic surgeons by 2025. Leaders warn this gap will worsen access to musculoskeletal care.
“Not enough providers, plenty of patients,” Philip Lim, MD, orthopedic surgeon at UCI Health (Orange, Calif.), told Becker’s in April. “Population growth continues to outpace the increase in the number of orthopedic residency positions, and this imbalance should translate into providers remaining busy going into the future.”
