Regional differences in reimbursement, volume, and patient characteristics exist for rotator cuff repairs: a temporal analysis from 2013 to 2021

• Published in: Journal of shoulder and elbow surgery 2025-01, Vol.34 (1), p.76-87
• Main Authors: Gill, Vikram S., Tummala, Sailesh V., Haglin, Jack M., Boddu, Sayi P., Cancio-Bello, Alexandra M., Tokish, John M.
• Format: Article
• Language: English
• Subjects: Aged; arthroscopy; Arthroscopy - economics; Arthroscopy - statistics & numerical data; Female; geographic-modification; Humans; Insurance, Health, Reimbursement - economics; Male; Medicare; Medicare - economics; practice style; Reimbursement; Retrospective Studies; rotator cuff; Rotator Cuff - surgery; Rotator Cuff Injuries - economics; Rotator Cuff Injuries - surgery; United States; utilization
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2024.03.034

Prior studies have demonstrated declining reimbursement and changing procedural utilization across multiple orthopedic subspecialties, yet a comprehensive examination of this has not been performed for rotator cuff repair (RCR), particularly at a geographic level. The purpose of this study was to evaluate changes in reimbursement, utilization, and patient populations for open and arthroscopic RCRs from 2013 to 2021 at a national and regional level. The Medicare Physician and Other Practitioners database from years 2013 to 2021 were queried to extract all episodes of open chronic RCR, open acute RCR, and arthroscopic RCR. Utilization was measured as procedural volume per 10,000 Medicare beneficiaries. Inflation-adjusted reimbursement, utilization, surgeon information, and patient characteristics were extracted for each procedure for each year. Data was stratified geographically based on US Census regions and rural-urban commuting codes. Kruskal-Wallis tests and linear regressions were performed to compare geographical areas. Between 2013 and 2021, arthroscopic RCR utilization increased by 9.4% (11.0/10,000-12.0/10,000), while open chronic RCR utilization decreased by 58.8% (2.0/10,000-0.8/10,000). During that time, average inflation-adjusted reimbursement declined by 10.0% and 11.3% for arthroscopic and open chronic RCR, respectively. The increase in utilization and decrease in reimbursement was greatest in the Midwest. In 2021, arthroscopic RCR utilization was 12.0/10,000, while average reimbursement was $846.87, nationally. Utilization was highest in the South (14.5/10,000) and lowest in the Northeast (8.1/10,000) (P