The Centers for Medicare & Medicaid Services (CMS) has proposed a 20% cut to the primary codes for total hip and knee arthroplasty (THA/TKA) for 2027. This unprecedented reduction in reimbursement to Medicare’s top procedures is the latest of a string of increasingly frequent cuts, including a 10.5% cut previously this year. As many commercial insurers reimburse physicians based on Medicare Fee For Service rates, it is expected that payments for hip and knee surgery for Medicare Advantage patients will be severely reduced as well.

The American Association of Hip and Knee Surgeons (AAHKS) is committed to reducing health care costs and improving patient outcomes. Hip and knee surgeons have achieved great success in this regard by innovations such as optimizing patients’ overall health prior to scheduling surgery, treating most patients in the outpatient setting and participating in bundled payment programs to control the overall costs of care. These improvements in treating hip and knee patients take more time and effort on the part of surgeons compared to older, less efficient ways. CMS has been relentless in recognizing ways in which surgeons no longer do things, like daily rounds on patients recovering in the hospital while turning a blind eye to the time and effort it takes to achieve these improvements, such as presurgical patient optimization.

The physician’s fees for THA and TKA only account for 6% of the total cost of a joint replacement. So severe surgeon reimbursement reduction cannot significantly reduce the overall cost to Medicare of providing hip and knee replacements that so many seniors need to remain mobile and pain-free. The government’s strategy appears to be to reduce surgeons’ reimbursement to the point that fewer physicians will be willing or able to take on this difficult work, thereby reducing patients’ access to treatment. This kind of de facto rationing is seen in Canada, the United Kingdom and some European countries where the capacity to obtain treatment is far below the need, and patients may wait several years before obtaining relief by surgical intervention.

AAHKS advocates a proven alternative to this Draconian approach. Hip and knee surgeons have documented their success as value-drivers for the Medicare program, optimizing patients prior to surgery, pioneering medical advancements that improve outcomes, reducing recovery time and restoring people to a healthier, more active life. 

CMS should accept the scientific evidence provided by AAHKS that justifies maintaining physician fee levels based on the work being done and the significant reductions achieved in the overall costs of hip and knee replacements. To stay on the path of endless physician fee cuts will only slow the momentum of physician-driven improvements and cost reductions, and accelerate the counterproductive market consolidation trend resulting from surgeons becoming employees of corporate health care systems because they can no longer maintain a medical practice at the reduced rates of reimbursement. CMS should maintain current Medicare reimbursement rates for joint replacement surgery in 2027.

Take action now to contact your Representative and Senators and urge them to sign-on to a Congressional letter urging CMS to maintain current reimbursement levels for hip and knee replacement surgery