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Orthopaedics or Plastics: Does Primary Surgical Specialty Have a “Hand” in Medicare Reimbursement
Michael P. Gaspar, MD; Patrick M. Kane, MD; Grace B. Honik, BS; Eon K. Shin, MD; Sidney M. Jacoby, MD; A. Lee Osterman, MD
The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA

Introduction: The purpose of this study was to examine the relationship between hand surgeons' self-designated primary surgical specialty and their reimbursement from Medicare.
Methods: We queried data from all surgeons with active membership in the American Society for Surgery of the Hand (ASSH) in 2012. Identifying data for ASSH members was matched with provider information from the Medicare database produced by the United States Centers for Medicare and Medicaid Services (CMS). Members who did not self-designate their primary specialty as “Orthopaedic Surgery,” “Hand Surgery,” or “Plastic and Reconstructive Surgery” were excluded. Average reimbursements were compared between specialists using ANOVA analysis for each service provided.
Results: A total of 1,660 surgeons satisfied inclusion: 714 self-designated their primary specialty as Hand Surgery (HS), 764 as Orthopaedic Surgery (OS), and 182 as Plastic and Reconstructive Surgery (PRS). Surgeons designated as either OS or HS had similar total CMS reimbursement at $72,530 and $72,021, respectively, while PRS had significantly less total average CMS reimbursement, at $32,477 per surgeon (p < 0.0001).
Among ancillary services, PRS received significantly smaller percentage of their total reimbursement from radiographs (PRS 1.4%, HS 7.6%, OS 7.7%, p < 0.0001), therapy (PRS 0.3%, HS 2.5%, OS 1.9%, p < 0.0001), and nerve testing (PRS 0.2%, HS 0.9%, OS 0.7%, p < 0.001). Proportion of reimbursement from office visits was greatest for PRS for both new (PRS 33.8%, HS 21.7%, OS 19.3%, p < 0.0001) and established patients (PRS 31.1%, HS 25.1%, OS 28.5%, p < 0.0001).
HS and OS had similar percentage of reimbursement from all surgical and in-office procedures (HS 41.7% vs. OS 41.1%) while PRS had a significantly lower proportion at 33.2% (p < 0.0001). For the most commonly billed surgical procedure, open carpal tunnel release (CPT 64721), PRS had significantly less total reimbursement ($7,249 vs. HS $11,046, OS $10,848, p < 0.0001), though average payment per surgery was not significantly different between the three groups.
Conclusions: Though plastic surgeons receive substantially less overall CMS reimbursement per surgeon than other ASSH members, reimbursement rates are comparable to hand and orthopaedic surgeons for commonly performed elective hand surgeries. Plastic surgeons receive a majority of CMS reimbursement from office visits, whereas orthopaedic and hand surgeons receive a larger proportion of CMS payment from ancillary services and procedures. There does not appear to be a significant difference among ASSH members designated as Orthopaedic Surgeons versus Hand Surgeons for CMS reimbursement.

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