Recent Findings from Johns Hopkins University Advance Knowledge in Managed Care (Remain-In or Opt-Out: An Economic Evaluation of Medicare Opt-Outs in Orthopaedic Surgery): Managed Care

2026 MAY 28 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Research findings on Managed Care are discussed in a new report. According to news reporting from Baltimore, Maryland, by NewsRx journalists, research stated, “Medicare reimbursements for orthopaedic surgeries have consistently declined over past decades, raising concerns about surgeons opting out of Medicare and reducing coverage for older adults. However, little is known about this phenomenon.”

The news correspondents obtained a quote from the research from Johns Hopkins University, “We conducted a retrospective evaluation of orthopaedic surgeon Medicare opt-outs as of January 2025. We analyzed charge-payment ratios of orthopaedic surgeries performed in areas with versus without opt-outs and examined the 3-year moving averages and population demographics for areas with opt-outs. As of January 2025, 341 orthopaedic surgeons have opted out of Medicare, representing 0.7% of all opted-out practitioners and 1.7% of 2022 Medicare-enrolled orthopaedic surgeons. The median charge-payment ratio for all orthopaedic surgeries is 18.3% higher in areas with these opt-outs compared with those without (95% confidence interval [CI], 11.7% to 30.1%; P< 0.0001) and 34.5% higher for joint arthroplasty and reconstruction surgeries (95% CI, 9.2% to 51.9%; P = 0.0003). These opt-outs primarily occurred in high-cost regions, with approximately 70% of surgeons practicing in areas with regional price parities greater than 110% of the national average. Consequently, Medicare opt-outs by orthopaedic surgeons have risen from 0.3 to 32.0 annually from 2002-2004 to 2022-2024. In 2022, there were 958 reported Medicare beneficiaries of orthopaedic surgeries per zip code in areas with opt-outs, 612 higher than in areas without opt-outs (95% CI, 277 to 629; P< 0.0001). The median proportion of Medicare-eligible individuals by age in areas with opt-outs is 35.8%, 18.1% higher than the national rate (95% CI, 16.3% to 19.3%; P< 0.0001). Orthopaedic surgeons practicing in high-cost and relatively lower reimbursed areas are increasingly opting out of Medicare, disproportionately affecting older adults and higher need areas.”

According to the news reporters, the research concluded: “These results suggest that correcting declining Medicare surgery reimbursements is critical to minimize coverage lapses for a growing older adult population, which is an important issue in orthopaedic surgery.”

This research has been peer-reviewed.

For more information on this research see: Remain-In or Opt-Out: An Economic Evaluation of Medicare Opt-Outs in Orthopaedic Surgery. Journal of the American Academy of Orthopaedic Surgeons, 2026. Journal of the American Academy of Orthopaedic Surgeons can be contacted at: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA.

Our news journalists report that additional information may be obtained by contacting Branden Lee, the Dept. of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.5435/jaaos-d-25-01405. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

Publisher contact information for the Journal of the American Academy of Orthopaedic Surgeons is: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA.

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