News from AAOS

[DrN2O]

Orthopedic Surgeons on Track to Earn Less Than Taco Bell Workers

If current trends continue, patients are in big trouble

www.medpagetoday.com

"If those numbers aren't disappointing enough for young surgeons who've already spent a dozen years in training, the same group fit a third-order polynomial model to historical data for Medicare reimbursements for arthroplasties, yielding a projection out to 2030. Actual figures from 2007 to 2023 showed mean reimbursements falling over time, and falling faster with each passing year from 2019 onward.


The resulting model resembles a letter S tipped onto its back: a steep decrease initially, flattening out in the middle, but then an accelerating decline in the final years. Rates fall off a cliff as the current decade proceeds, with mean reimbursements dropping to $200 or less in just a few more years.

Incredibly, the projection suggests physicians might get just $50 for a primary hip replacement in 2030. That's total, not per hour."

You may have to use a new browser to read the whole report, my apologies. Woes from ortho on declining reimbursement and comparing themselves to dentists. The click bait title even compared them to taco bell workers. Not sure if this is satirical or just common problems in US medicine. Thoughts?

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[kidthor]

Orthopedic Surgeons on Track to Earn Less Than Taco Bell Workers

If current trends continue, patients are in big trouble

www.medpagetoday.com

"If those numbers aren't disappointing enough for young surgeons who've already spent a dozen years in training, the same group fit a third-order polynomial model to historical data for Medicare reimbursements for arthroplasties, yielding a projection out to 2030. Actual figures from 2007 to 2023 showed mean reimbursements falling over time, and falling faster with each passing year from 2019 onward.


The resulting model resembles a letter S tipped onto its back: a steep decrease initially, flattening out in the middle, but then an accelerating decline in the final years. Rates fall off a cliff as the current decade proceeds, with mean reimbursements dropping to $200 or less in just a few more years.

Incredibly, the projection suggests physicians might get just $50 for a primary hip replacement in 2030. That's total, not per hour."

You may have to use a new browser to read the whole report, my apologies. Woes from ortho on declining reimbursement and comparing themselves to dentists. The click bait title even compared them to taco bell workers. Not sure if this is satirical or just common problems in US medicine. Thoughts?

If we were reimbursed at pure CMS rates then probably right now we as anesthesiologists are paid at about Taco Bell level (once you consider the CMS billing per time then subtract out all the non-reimbursed time, call time, expenses including insurance/malpractice/overhead, etc).

Plus we don't even have access to free crunchwrap supremes.

 

[teacher2md]

There’s some funny math going on here. I don’t see the link to the original paper, but this excerpt stood out:

“Covering a total of 334 surgeries, the mean total time per case was about 440 minutes both for total hip and total knee arthroplasties -- somewhat longer than the 404-407 minutes established by the American Medical Association's Relative Value Scale Update Committee (RUC) as the standards for these procedures. For hip replacements, reimbursements averaged $89 per hour”

“His group followed three such physicians in their first year post-fellowship, having them record how much time they personally spent around the time of surgery on each case. This included not just their work in the surgical suite but also the pre-operative meetings, planning, and note-writing along with post-operative visits and required paperwork.”

Does anyone here actually believe that an orthopedic surgeon spends 8 hours of total care for a THA or TKA?

How long do the initial visits usually take? I know the surgeons typically see 40+ patients per day with their PA/scribes. So, 15 minutes? How long do they spend rounding post op? 10 minutes per patient?

By their math, they get $645 total reimbursement per patient per surgery. I would estimate that their total time is closer to 180 minutes, which is closer to $215/hr.

Still bad, but not nearly what this article suggests. And still way more than anesthesia reimbursement, by the way.

 

[Dr. Rude]

Orthopedic Surgeons on Track to Earn Less Than Taco Bell Workers

If current trends continue, patients are in big trouble

www.medpagetoday.com

"If those numbers aren't disappointing enough for young surgeons who've already spent a dozen years in training, the same group fit a third-order polynomial model to historical data for Medicare reimbursements for arthroplasties, yielding a projection out to 2030. Actual figures from 2007 to 2023 showed mean reimbursements falling over time, and falling faster with each passing year from 2019 onward.


The resulting model resembles a letter S tipped onto its back: a steep decrease initially, flattening out in the middle, but then an accelerating decline in the final years. Rates fall off a cliff as the current decade proceeds, with mean reimbursements dropping to $200 or less in just a few more years.

Incredibly, the projection suggests physicians might get just $50 for a primary hip replacement in 2030. That's total, not per hour."

You may have to use a new browser to read the whole report, my apologies. Woes from ortho on declining reimbursement and comparing themselves to dentists. The click bait title even compared them to taco bell workers. Not sure if this is satirical or just common problems in US medicine. Thoughts?

If a trend can't go on forever, it won't. This trend can't. Along with lots of others.

 

[UscGhost]

There’s some funny math going on here. I don’t see the link to the original paper, but this excerpt stood out:

“Covering a total of 334 surgeries, the mean total time per case was about 440 minutes both for total hip and total knee arthroplasties -- somewhat longer than the 404-407 minutes established by the American Medical Association's Relative Value Scale Update Committee (RUC) as the standards for these procedures. For hip replacements, reimbursements averaged $89 per hour”

“His group followed three such physicians in their first year post-fellowship, having them record how much time they personally spent around the time of surgery on each case. This included not just their work in the surgical suite but also the pre-operative meetings, planning, and note-writing along with post-operative visits and required paperwork.”

Does anyone here actually believe that an orthopedic surgeon spends 8 hours of total care for a THA or TKA?

How long do the initial visits usually take? I know the surgeons typically see 40+ patients per day with their PA/scribes. So, 15 minutes? How long do they spend rounding post op? 10 minutes per patient?

By their math, they get $645 total reimbursement per patient per surgery. I would estimate that their total time is closer to 180 minutes, which is closer to $215/hr.

Still bad, but not nearly what this article suggests. And still way more than anesthesia reimbursement, by the way.

I would also add time waiting for the case to start, OR turnover, dictations, etc

First year out of fellowship also means slower in all aspects of daily work versus a more experienced doc who can multitask during delays.

Would be a hard number to truly calculate, but generally most surgeons feel they lose money on surgery and make money in clinic.

 

[GassYous]

A total hip should take like an hour.
Flip two rooms with someone to close you can get 8 totals done in a day and out by 3

 

[UscGhost]

A total hip should take like an hour.
Flip two rooms with someone to close you can get 8 totals done in a day and out by 3

Most don't get that unless very high volume and experienced. So a first year post fellowship shouldn't get that.

But the experienced and consistently efficient surgeons can, but they are generally the exception rather than the baseline expectation

 

[Dr. Rude]

Most don't get that unless very high volume and experienced. So a first year post fellowship shouldn't get that.

But the experienced and consistently efficient surgeons can, but they are generally the exception rather than the baseline expectation

And in the name of efficiency and productivity, the model may change.

Some “surgeons” who are averageish technically do mostly preop and post op care. The slickest technically will do little more than operate: no office hours, preop or post op care.

 

[DrN2O]

I would also add time waiting for the case to start, OR turnover, dictations, etc

First year out of fellowship also means slower in all aspects of daily work versus a more experienced doc who can multitask during delays.

Would be a hard number to truly calculate, but generally most surgeons feel they lose money on surgery and make money in clinic.

I feel the same way about anesthesia. When people mention their hourly rate, is that OR time only? What is the true rate if you take into account preparation, turn over, preop, and postop checks?

 

[dozitgetchahi]

I would also add time waiting for the case to start, OR turnover, dictations, etc

First year out of fellowship also means slower in all aspects of daily work versus a more experienced doc who can multitask during delays.

Would be a hard number to truly calculate, but generally most surgeons feel they lose money on surgery and make money in clinic.

I donno, I’ve always heard the exact opposite from surgeons? The big money is always said to be in billing surgical procedures, and clinic is whatever? I’ve always been told that a lot of surgeons basically don’t even write billable notes because they don’t give a rip about billing clinic visits?

 

[UscGhost]

I donno, I’ve always heard the exact opposite from surgeons? The big money is always said to be in billing surgical procedures, and clinic is whatever? I’ve always been told that a lot of surgeons basically don’t even write billable notes because they don’t give a rip about billing clinic visits?

Probably depends on the surgical field.

But if they can generate 200-300 per patient and they can see 40 patients in a day, it's generally more lucrative than doing 3-4 surgeries plus rounds where they make 1200 per surgery

 

[anbuitachi]

i suspect there is OVERLAP that is double counted. THe first patient may be recovering in PACU, that is counted toward the time for first patient. But during that time , the surgeon can be working on the second patient. Total time for each patient may be 440m, but how much of that may be overlap? Otherwise, that is like 1 case per day if they work 8 hours, resulting in 260 cases per year. if they work 12 hours thats 390 cases. I say BS.

But unfortunately, ortho isnt going to get a huge amount of sympathy since they are one of the highest paid physicians... one of the few specialties that can realistically make 1m++ a year

 

[NightyNight]

Joint values will drop just like GI and cataracts. Orthopedics won’t be the big dog down the road anymore. Something else will be skewed high and people will want to do that.

Hospital fees keep rising. Working folks get less but face the liability. What’s the government going to do about it? Nothing until it’s too late. Wish I didn’t need to work another 15-20 years.

 

[anbuitachi]

Joint values will drop just like GI and cataracts. Orthopedics won’t be the big dog down the road anymore. Something else will be skewed high and people will want to do that.

Hospital fees keep rising. Working folks get less but face the liability. What’s the government going to do about it? Nothing until it’s too late. Wish I didn’t need to work another 15-20 years.

i mean its a broken system. our healthcare is a broken system.
our country is a capitalist country and healthcare here is a business. especially now that PE is more and more involved, the bottom folks like doctors will get squeezed more and more by those seeking profits.

the future is unionizing of physicians. the way it is currently working is keep working more hours to make more money, or do more cases. reimbursements dont keep up with inflation. it just doesnt work LONG term =\

 

[jwk]

There’s some funny math going on here. I don’t see the link to the original paper, but this excerpt stood out:

“Covering a total of 334 surgeries, the mean total time per case was about 440 minutes both for total hip and total knee arthroplasties -- somewhat longer than the 404-407 minutes established by the American Medical Association's Relative Value Scale Update Committee (RUC) as the standards for these procedures. For hip replacements, reimbursements averaged $89 per hour”

“His group followed three such physicians in their first year post-fellowship, having them record how much time they personally spent around the time of surgery on each case. This included not just their work in the surgical suite but also the pre-operative meetings, planning, and note-writing along with post-operative visits and required paperwork.”

Does anyone here actually believe that an orthopedic surgeon spends 8 hours of total care for a THA or TKA?

How long do the initial visits usually take? I know the surgeons typically see 40+ patients per day with their PA/scribes. So, 15 minutes? How long do they spend rounding post op? 10 minutes per patient?

By their math, they get $645 total reimbursement per patient per surgery. I would estimate that their total time is closer to 180 minutes, which is closer to $215/hr.

Still bad, but not nearly what this article suggests. And still way more than anesthesia reimbursement, by the way.

The ortho guys laugh all the way to the bank. The majority of our total joints are under one hour of operating time. Several surgeons do it in under 30 minutes. Most have PAs helping them - and of course that time is also billable. Face time from the surgeon prior to surgery is probably 15 minutes or less, ditto for the 6-week postop check. All the rest is done by PAs or NPs.

 

[UscGhost]

The ortho guys laugh all the way to the bank. The majority of our total joints are under one hour of operating time. Several surgeons do it in under 30 minutes. Most have PAs helping them - and of course that time is also billable. Face time from the surgeon prior to surgery is probably 15 minutes or less, ditto for the 6-week postop check. All the rest is done by PAs or NPs.

They would generally still need two rooms or a highly efficient OR.

Otherwise, 7am start, 730 cut, out of OR 915, next case in around 10. Plus or minus 30 mins.

Must be different surgeons where you are at. Out of the 15 surgeons I know, only 1 can do it in under an hour of operative time. Unless you aren't counting the closing time

 

[chessknt]

Probably depends on the surgical field.

But if they can generate 200-300 per patient and they can see 40 patients in a day, it's generally more lucrative than doing 3-4 surgeries plus rounds where they make 1200 per surgery

I'd love to hear how they write high level MDM new patient visits on 40 people a day. Not even the most scammy PCP mills can generate that kind of revenue and there are far more people with sniffles and random complaints than there are people who need Ortho evals. 800 patients a month in clinic huh? That's probably 2-3x what an average PCP sees...

 

[UscGhost]

I'd love to hear how they write high level MDM new patient visits on 40 people a day. Not even the most scammy PCP mills can generate that kind of revenue and there are far more people with sniffles and random complaints than there are people who need Ortho evals. 800 patients a month in clinic huh? That's probably 2-3x what an average PCP sees...

I don't know how many are new versus pre-op/postop. They usually just say "I have 30 patients in clinic today"

Usually clinic isn't everyday as well.

I don't have any insight into clinic billing beyond what they casually say during cases. But most seem to feel that the OR doesn't generate as much revenue.

Speed and efficiency can be the difference though for sure

 

[chessknt]

I don't know how many are new versus pre-op/postop. They usually just say "I have 30 patients in clinic today"

Usually clinic isn't everyday as well.

I don't have any insight into clinic billing beyond what they casually say during cases. But most seem to feel that the OR doesn't generate as much revenue.

Speed and efficiency can be the difference though for sure

E/m billing is pretty **** at 10 minutes per patient, like sub $100. Billing 40 level 4-5s per day would trigger a federal audit.