A Study of Arthroplasty Surgeons Who Opt Out of Medicare.

Background: Physicians may choose to opt out of accepting reimbursements through the Medicare program. There is limited information on arthroplasty surgeons who elect to opt out of Medicare.

Methods: The public Centers for Medicare & Medicaid Services Opt-Out Affidavits Dataset was used to identify individual orthopaedic surgeons performing hip and knee arthroplasty who had opted out of Medicare as of February 2024. Publicly available internet pages were used to investigate individual surgeon characteristics and evaluate trends among those surgeons who opted out of Medicare over time.

Results: Of the 308 orthopaedic surgeons who did not accept Medicare, 85 performed hip and/or knee arthroplasty. Of these surgeons, 37% practiced in or near New York City, while 27% practiced in the Southwest United States. All practiced in urban areas. At the time of opt out, physicians had an average time in practice of 21.3 years and a median of 20 years (range, five to 46). Surgeons had an average H-index of 17.6 and a median of six (range, zero to 82). Approximately, half of the surgeons were fellowship-trained in arthroplasty. Of these, 39% completed their training at the same institution. Surgeons received a mean of $377,178 and a median of $2,520 (range, zero to $10,631,606) from industry payments in the most recent year. This includes 47 (56%) who received less than $5,000 and nine (11%) who received over $1,000,000. In addition, 53% accepted insurance plans other than Medicare, and 25% had ownership of outpatient surgery centers. Also, the annual incidence of arthroplasty surgeon opt outs was higher in 2023 than in any year previously.

Conclusions: Arthroplasty surgeons who opt out of Medicare have diverse demographic, academic, and financial characteristics. Features commonly shared were geographic location and fellowship institution, while other characteristics vary substantially.