Springer, Bryan D.

Abstract Background Little research exists regarding geographic comparisons within the United States for Medicaid reimbursement. We compared Medicaid reimbursement for a broad range of orthopedic surgery codes from each state on a geographic and state level. Methods We obtained Medicaid reimbursement rates in each state for 211 orthopedic procedure codes along with corresponding work Relative Value Units (wRVUs). Rates were divided by wRVUs to control for differences between procedures and subspecialties. States were designated as either West, Midwest, South, or Northeast. Kruskal-Wallis tests with Dunn’s post-hoc analyses ascertained differences between regions and each orthopedic subspecialty by state. Coefficient of variation (CoV) values were calculated to measure the amount of variability in rates. A Kruskall-Wallis with Dunn’s post-hoc test assessed differences in quartiles for reimbursement compared to a square miles per orthopedic surgeon ratio. Results The West region reimbursed the highest at $72.92/wRVU and the Northeast reimbursed the lowest at $51.78. Hand surgery was the highest reimbursing subspecialty ($94.58/wRVU) and Oncology the lowest ($62.89/wRVU). The CoV ranged from 0.15–0.77 by state and 0.27–0.50 by subspecialty. A linear regression model between wRVU-adjusted Medicaid reimbursement and square miles per surgeon yielded an R2 value of 0.453. States with the most land area relative to orthopedic surgeons reimbursed significantly higher. Conclusion The West geographic region is associated with the highest Medicaid reimbursement for orthopedic procedures, and the Northeast the lowest. Wide variability was seen in rates, both between states and within states. Large, sparsely-populated states may increase Medicaid reimbursement as a tactic to attract physicians. Level of Evidence: IV; Economic Analysis