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The Orthopaedic Forum   |    
Medicare and the Orthopaedic Surgeon: Challenges in Providing, Financing, and Accessing Musculoskeletal Care for the Elderly*
Kevin J. Bozic, MD, MBA1; Bonnie Cramer, MSW2; Todd J. Albert, MD3
1 Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728. E-mail address: kevin.bozic@ucsf.edu
2 Chair, Board of Directors, AARP, 601 E Street N.W., Washington, DC 20049
3 Department of Orthopaedic Surgery, Thomas Jefferson University and Hospitals, 925 Chestnut Street, Philadelphia, PA 19107
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (United HealthCare Pacific Business Group on Health, Integrated Healthcare Association, and DePuy Spine [royalties]).

This report is based on a symposium presented at the Annual Meeting of the American Orthopaedic Association on June 11, 2009, in Bonita Springs, Florida.

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jun 01;92(6):1568-1574. doi: 10.2106/JBJS.I.01189
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The U.S. health-care system is currently facing numerous challenges that threaten its long-term viability. Uncontrollable inflation of health-care costs coupled with concerns about highly variable quality and declining access to care have led to calls for a complete overhaul of the system1,2. The federal government, as the primary payer for a substantial portion of health care in the U.S.3, is actively involved in the debate over health-care reform. In fiscal year 2010, Medicare will provide health insurance to forty-seven million individuals who are over the age of sixty-five years, are disabled, or have end-stage renal disease, at a cost of roughly $510 billion. Over the past decade, Medicare provider reimbursement has trailed medical inflation, leading some orthopaedic surgeons to reconsider their participation in the program, others to "quietly" restrict access to Medicare patients, and a small number to completely opt out of the program. In this report, we explore various stakeholder perspectives on the challenges in providing, financing, and accessing musculoskeletal care for the elderly through the Medicare system and discuss potential strategies for addressing these challenges.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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