This study tracks Medicare reimbursement for the 20 most common orthopaedic trauma CPT codes from 2000 to 2020. All values were adjusted to 2020 dollars using CPI to determine whether surgeons are being paid more or less in real terms. The central question: has nominal reimbursement growth kept pace with inflation?
A 4.9% nominal pay increase over 20 years sounds acceptable until you account for 52.8% inflation — at that point, it represents a 30% real-dollar pay cut. That is the core finding here, and it matters for every trainee entering the workforce.
Foot and ankle trauma took the hardest hit at -42.6% in real terms. The authors raise the concern that sustained financial pressure could subtly shift operative decision-making away from complex foot and ankle fractures over time.
As a resident, understanding RVU structure is essential. Total RVUs barely moved (+4.4%), but malpractice RVUs exploded (+109.8%) while practice expense RVUs fell (-11.5%). CMS is not simply paying less. It is reallocating what it pays for, shifting resources toward liability and away from the cost of running a practice.
The SGR is repealed, but its replacement (MACRA/MIPS) was still in early rollout at publication. How value-based payment reform ultimately affects trauma reimbursement remains an open and consequential question for your generation of surgeons.
This study tracks Medicare reimbursement for the 20 most common orthopaedic trauma CPT codes from 2000 to 2020. All values were adjusted to 2020 dollars using CPI to determine whether surgeons are being paid more or less in real terms. The central question: has nominal reimbursement growth kept pace with inflation?
A 4.9% nominal pay increase over 20 years sounds acceptable until you account for 52.8% inflation — at that point, it represents a 30% real-dollar pay cut. That is the core finding here, and it matters for every trainee entering the workforce.
Foot and ankle trauma took the hardest hit at -42.6% in real terms. The authors raise the concern that sustained financial pressure could subtly shift operative decision-making away from complex foot and ankle fractures over time.
As a resident, understanding RVU structure is essential. Total RVUs barely moved (+4.4%), but malpractice RVUs exploded (+109.8%) while practice expense RVUs fell (-11.5%). CMS is not simply paying less. It is reallocating what it pays for, shifting resources toward liability and away from the cost of running a practice.
The SGR is repealed, but its replacement (MACRA/MIPS) was still in early rollout at publication. How value-based payment reform ultimately affects trauma reimbursement remains an open and consequential question for your generation of surgeons.