CMS’ proposed 2027 cut of roughly 20% to Medicare physician payment for total hip and knee replacement could shrink seniors’ access to joint replacement and worsen orthopedic workforce shortages, three orthopedic surgeons argued in an Oct. 20 commentary in AAOS Now.
The authors are Dhairya Shukla, MD, a fourth-year orthopedic resident at Bethlehem, Pa.-based St. Luke’s University Health Network; P. Maxwell Courtney, MD, an orthopedic surgeon at Philadelphia-based Rothman Orthopaedics and chair of the American Association of Hip and Knee Surgeons’ advocacy committee; and Douglas Lundy, MD, chair of orthopedic surgery at St. Luke’s.
CMS released the proposed physician fee schedule July 14. The American Academy of Orthopaedic Surgeons and AAHKS both estimate the rule cuts physician payment for primary hip and knee replacement codes by about 20%. Inflation-adjusted Medicare reimbursement for the procedures already fell about 56% from 2000 to 2024.
The authors argued that CMS is treating shorter hospital stays as less surgeon work, when that work has shifted to preoperative optimization and post-discharge follow-up. They cited research showing surgeons log an average of 153 minutes of preoperative work that goes unbilled.
The surgeon’s fee makes up less than 4% of a joint replacement episode’s cost, the authors wrote, while 2026 facility rates rose 10% for hospital outpatient departments and 5% for ambulatory surgery centers.
The authors said “we are at a breaking point,” warning the cut could lead surgeons to stop taking Medicare, cap Medicare patients or sell to larger organizations. Meanwhile, the average arthroplasty caseload per surgeon is projected to climb from 65.2 in 2017 to 139.4 by 2050 as the orthopedic surgeon workforce shrinks.
Hip and knee replacement will also be the first procedures in CMS’ nationwide mandatory bundled payment program, starting in 2028.
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