State Variation in Medicaid Reimbursements for Orthopedics Surgery

Summary:

The goal of this study was to quantify the variation for commonly performed inpatient orthopedic procedures, as Medicaid reimbursements are determined by each state and are subject to variability.
The 10 most commonly performed inpatient orthopedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. The study concluded that Variability of Medicaid reimbursement for inpatient orthopedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

Citation: Lalezari RM, Pozen A, Dy CJ. State Variation in Medicaid Reimbursements for Orthopedics Surgery. The Journal of Bone and Joint Surgery. 2018 Feb 7; 100 (3): 236. DOI: 10.2106/JBJS.17.00279. Link to Article>>