Trends in orthopedics: an analysis of Medicare claims, 2000-2010.

The complete Medicare Part B claims databases for the years 2000 through 2010 were queried. Musculoskeletal procedures were grouped into 12 anatomical or functional groups for multiyear analysis. Utilization rates per 1000 Medicare beneficiaries and spending per Medicare beneficiary were calculated. Compound annual growth rates were used to compare spending trends with national health care spending data. Medicare payments for orthopedic procedures increased 63.7% in 10 years, from $1.6 billion in 2000 to $2.6 billion in 2010. The number of procedures increased by a similar proportion, from 8.2 to 13.6 million (66.9%); the average reimbursement per procedure decreased slightly. The overall utilization rate increased by 41.4% over the past decade, from 206.73 to 292.41 per 1000 beneficiaries. Considerable variation was found when these procedures were analyzed, with utilization rates per 1000 beneficiaries ranging from large increases (spine, +214.5%; endoscopy, +128%) to modest decreases (hand and fingers, -9.9%). Payment trends, corrected for inflation and growth in the number of Medicare enrollees, showed similar heterogeneity. Payment per beneficiary increased at only 0.65% above inflation for orthopedic procedures, well below the 4.67% compound annual growth rate seen for overall Medicare spending.These data demonstrate that, despite significant increases in its utilization, orthopedics does not appear to be a driver for increases in Medicare spending over the past decade. Only spinal and endoscopic procedures stand out as having experienced exceptional growth; demonstration of clinical success and cost effectiveness in these areas would be helpful to strengthen support for these evolving trends in orthopedic practice.