CMS, EDS, and ABOS

So if I may, um, you know, I st- I, I am always intrigued by, um, billing and coding.

You know? Um, I'm intrigued by payers, et cetera.

And so CMS dropped their, uh, planned 2027, um, both conversion factor, which influences how much we're paid, and some little tidbits, um, and I have to say, I'd love to share those, if that's okay with you, just briefly, and, uh, some of our readers may have some comments, and we would welcome, um, an email with any comments from readers.

So the first one, and the most-

Hold on, hold on, hold on.

Before you do that-

Yeah

... two things.

I, I do wanna tell people, because if you're about to fast-forward throughout this entire episode, there will be some clinical content, [laughs] uh, reader, uh, listener mail bag that we're gonna go through.

Uh, but at least a couple of thoughts for our new fellows starting out.

Um, I just didn't want them, you know, the people that don't like the policy stuff to completely fall asleep.

Uh, but that being said, uh, CMS, and for those outside of the United States, that's the Center for Medicare and M- uh, Medicare and Medicaid Services, uh, so they kind of set the bar for what things, how things get reimbursed, uh, for the government insurance in the US.

Uh, so Medicare is for those over 65.

Medicaid is a state-by-state program, um, but is for those that are financially not doing well.

And then, um, you know, so they set the bar, and then private insurers tend to follow kind of the bar that CMS sets.

Um, so every year there's a new fee schedule that comes out, uh, which, you know, sort- causes all sorts of consternation because if you adjust one, you're gonna have to adjust another.

So say, like, you want...

You think we should get paid more for a certain procedure, it's gotta come from somewhere because it is literally a zero-sum game.

So it might come from within the world of hand surgery or within the world of orthopedics, or you might be robbing from neurosurgery or nephrology or something else.

Yeah.

Re- both caveats are great, so thank you for saying that.

And, um, you know, the, the, the...

Those from outside of the United States listening may find this appalling, may find it fascinating.

Um, i-i- our United States system is broken on so many different levels, and this captures part of it, but your, your con- your, your mention of a pool of money that theoretically doesn't get any bigger is really an important one.

So there are winners, and there are losers, and, you know, orthopedic surgery is a loser, uh, for 2027.

So if I may, um, you know, I st- I, I am always intrigued by, um, billing and coding.

You know? Um, I'm intrigued by payers, et cetera.

And so CMS dropped their, uh, planned 2027, um, both conversion factor, which influences how much we're paid, and some little tidbits, um, and I have to say, I'd love to share those, if that's okay with you, just briefly, and, uh, some of our readers may have some comments, and we would welcome, um, an email with any comments from readers.

So the first one, and the most-

Hold on, hold on, hold on.

Before you do that-

Yeah

... two things.

I, I do wanna tell people, because if you're about to fast-forward throughout this entire episode, there will be some clinical content, [laughs] uh, reader, uh, listener mail bag that we're gonna go through.

Uh, but at least a couple of thoughts for our new fellows starting out.

Um, I just didn't want them, you know, the people that don't like the policy stuff to completely fall asleep.

Uh, but that being said, uh, CMS, and for those outside of the United States, that's the Center for Medicare and M- uh, Medicare and Medicaid Services, uh, so they kind of set the bar for what things, how things get reimbursed, uh, for the government insurance in the US.

Uh, so Medicare is for those over 65.

Medicaid is a state-by-state program, um, but is for those that are financially not doing well.

And then, um, you know, so they set the bar, and then private insurers tend to follow kind of the bar that CMS sets.

Um, so every year there's a new fee schedule that comes out, uh, which, you know, sort- causes all sorts of consternation because if you adjust one, you're gonna have to adjust another.

So say, like, you want...

You think we should get paid more for a certain procedure, it's gotta come from somewhere because it is literally a zero-sum game.

So it might come from within the world of hand surgery or within the world of orthopedics, or you might be robbing from neurosurgery or nephrology or something else.

Yeah.

Re- both caveats are great, so thank you for saying that.

And, um, you know, the, the, the...

Those from outside of the United States listening may find this appalling, may find it fascinating.

Um, i-i- our United States system is broken on so many different levels, and this captures part of it, but your, your con- your, your mention of a pool of money that theoretically doesn't get any bigger is really an important one.

So there are winners, and there are losers, and, you know, orthopedic surgery is a loser, uh, for 2027.