Declining Medicare reimbursement and income in primary total shoulder arthroplasty: a comparison of osteopathic and allopathic orthopedic surgeons, 2013-2023
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Medicare reimbursement for arthroplasty, including total shoulder arthroplasty (TSA), has declined over the past decade. The purpose of this study is to determine whether Medicare reimbursement differed between osteopathic (DO) and allopathic (MD) orthopedic physicians performing primary TSA and how this has changed over time. Methods The Centers for Medicare and Medicaid Services databases were queried from 2013 to 2023 to identify physicians billing the Current Procedural Terminology code 23472 (primary TSA). Physicians were stratified by degree (12,518 MD vs. 1,167 DO). All monetary values were adjusted to 2023 United States dollars using the Consumer Price Index. Procedural reimbursement was defined as the Centers for Medicare and Medicaid Services–reported average Medicare standardized amount. Annual procedural income (API) was a physician's Medicare income from TSA (Current Procedural Terminology code 23472), calculated as average Medicare standardized amount multiplied by services billed. Results In 2013, DO physicians earned 31% ($11,493) less in API than MD physicians ($25,704 vs. $37,197; P < .001), with 24% fewer mean years in practice (14 vs. 19; P < .001) and 30% fewer mean services (18 vs. 25; P < .001). In 2023, DO physicians earned 26% ($8,422) less in API than MD physicians ($24,001 vs. $32,423; P < .001), with 21% fewer mean years in practice (18 vs. 22; P < .001) and 25% fewer mean services (22 vs. 29; P < .001). From 2013 to 2023, the proportion of DO providers doubled (5% vs. 10%), as did their share of TSA services (4% vs. 8%). Over this time, procedural reimbursement did not differ significantly between degree types. However, DO physicians experienced a 23% ($335) decline in procedural reimbursement ($1,444 vs. $1,109; P < .001), with no significant change in mean services ( P = .073) or API ( P = .524), while MD physicians experienced a 24% ($345) decline in procedural reimbursement ($1,458 vs. $1,113; P < .001) despite billing 15% more mean services (25 vs. 29; P < .001), resulting in a 13% ($4,774) decline in API ($37,197 vs. $32,423; P < .001). Conclusion By 2023, MD physicians experienced a 13% decline in API compared with 2013 despite averaging 15% more services, highlighting a concerning trend of providers working more for less. Both MD and DO physicians had significant declines in procedural reimbursement over this period (24% and 23%, respectively) despite a 31% rise in inflation. Although procedural reimbursement did not differ between degree types in either year, DO physicians consistently billed 7 fewer services and earned $11,493 less in API in 2013 and $8,422 less in 2023.
Authors: Anthony J. Minerva, John W. Moore, Annie Jinks, Jason Silvestre, Brandon L. Rogalski, Richard J. Friedman
Institution: Medical University of South Carolina
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W7126249467