Medicare's Post-Acute Care Reimbursement Models as of 2023: Past, Present, and Future

• Published in: Journal of bone and joint surgery. American volume 2024-08, Vol.106 (16), p.1521-1528
• Main Authors: Siddiqi, Ahmed, Pasqualini, Ignacio, Tidd, Joshua, Rullán, Pedro J, Klika, Alison K, Murray, Trevor G, Johnson, Joshua K, Piuzzi, Nicolas S
• Format: Article
• Language: English
• Subjects: Fee-for-Service Plans - economics; Forecasting; Humans; Medicare - economics; Orthopedics - economics; Reimbursement Mechanisms - economics; Reimbursement, Incentive - economics; Subacute Care - economics; United States
• ISSN: 0021-9355; 1535-1386; 1535-1386
• DOI: 10.2106/JBJS.23.00422

The Centers for Medicare & Medicaid Services is continually working to mitigate unnecessary expenditures, particularly in post-acute care (PAC). Medicare reimburses for orthopaedic surgeon services in varied models, including fee-for-service, bundled payments, and merit-based incentive payment systems. The goal of these models is to improve the quality of care, reduce health-care costs, and encourage providers to adopt innovative and efficient health-care practices.This article delves into the implications of each payment model for the field of orthopaedic surgery, highlighting their unique features, incentives, and potential impact in the PAC setting. By considering the historical, current, and future Medicare reimbursement models, we hope to provide an understanding of the optimal payment model based on the specific needs of patients and providers in the PAC setting.