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32 PRACTICE MANAGEMENT What are the Driving Forces Behind Medicare Reimbursement for Total Joint Arthroplasty? 7 Key Notes By Eric Oliver A study in The Journal of Bone & Joint Surgery presented the biggest variables affecting total joint arthroplasty reimburse- ment. The study uses standard economic and healthcare specific variables. Here is what you need to know. 1. The researchers examined 527,207 total joint arthroplasties with a weighted mean reimbursement of $14,324.84. The range of reimbursement was as low as $9,103 to as high as $38,686. 2. Total joint arthroplasty provider volume and patient satis- faction were both negatively correlated with reimbursement. Government ownership of a hospital coupled with higher Medicare costs correlated positively. 3. The researchers concluded that the reimbursement rate was variable. 4. Factors associated with a high reimbursement rate include: • Lower patient volume • Lower patient satisfaction • A healthier patient population • Government ownership of a hospital 5. To prepare for value-based care, providers should expect dramatic changes in total joint reimbursement. The following will affect reimbursement: • Patient volume • Willingness to care for sicker patient populations • Patient satisfaction • Safe outcomes • Procedural demand 6. Researchers examined inpatient charge or reimbursement data for 2,750 hospitals with at least 10 discharges for un- complicated total joint arthroplasty for the 2011 fiscal year. The researchers also examined reimbursement variability us- ing the Dartmouth Atlas. 7. The researchers said the findings need more investigation and collaboration between policymakers and providers to develop value-based reimbursement. n The Specialist Most Likely to 'Cherry-Pick' Patients: 25 Statistics By Laura Dyrda A ccording to the "Medscape Ethics Report 2016: Money, Romance, and Patients" a percentage of most physicians report they would "cherry-pick" or "lemon-drop" patients to avoid those with a comorbid disease or patients that are unlikely to follow a treatment regimen. Eighteen percent of primary care physi- cians said they would "cherry-pick" or "lem- on-drop"; 17 percent of specialists said the same. Here is the breakdown by specialty: 1. Orthopedics: 38 percent 2. Plastic surgery: 38 percent 3. Urology: 27 percent 4. Gastroenterology: 24 percent 5. Hematology: 27 percent 6. Anesthesiology: 22 percent 7. General surgery: 21 percent 8. Dermatology: 20 percent 9. Diabetes and endocrinology: 19 percent 10. Rheumatology: 19 percent 11. Cardiology: 18 percent 12. Family medicine: 18 percent 13. Internal medicine: 18 percent 14. Psychiatry and mental health: 18 percent 15. Nephrology: 17 percent 16. OB/GYN and women's health: 17 percent 17. Allergy and immunology: 16 percent 18. Emergency medicine: 15 percent 19. HIV/AIDS: 15 percent 20. Radiology: 15 percent 21. Pulmonary medicine: 14 percent 22. Neurology: 12 percent 23. Oncology: 11 percent 24. Pediatrics: 9 percent 25 Pathology: 8 percent ere were some specialists who reported they couldn't take the more complicated cases be- cause it would decrease income and put their business in jeopardy; other specialists said they advise patients with significant comorbidities about the high risk of complications and steer them toward nonoperative solutions. n