Dear Patients and Colleagues:
I am very excited to share the news that Medicare has finally done the right thing and, starting in January of 2024, will allow surgeons in the United States to do shoulder replacements in
ambulatory surgical centers (ASC). As many of you know, I have had to severely limit the number of Medicare patients I could see in the office due to my departure from the hospitals systems in May of 2023. The reason that I reduced my Medicare practice derived from the rules within Medicare that were preventing payment to physicians that would not perform the total shoulder replacement surgery at a hospital. As my practice is exclusively a shoulder practice for 20 years, this rule had a disproportionately negative impact on my practice.
ambulatory surgical centers (ASC). As many of you know, I have had to severely limit the number of Medicare patients I could see in the office due to my departure from the hospitals systems in May of 2023. The reason that I reduced my Medicare practice derived from the rules within Medicare that were preventing payment to physicians that would not perform the total shoulder replacement surgery at a hospital. As my practice is exclusively a shoulder practice for 20 years, this rule had a disproportionately negative impact on my practice.I have been one of the most high volume and experienced shoulder replacement surgeons in the United States for many years and many of the shoulder replacements I perform are done on Medicare-aged patients. Ironically, total hip and knee replacements were allowed by Medicare during the Trump Administration (remember that Medicare is not a ‘real’ insurance company…but, a political organization as a Government Payer). And, as if “truth were stranger than fiction”, the only standard procedure an orthopedic surgeon cannot do in an ASC for Medicare is a total shoulder replacement…I am permitted to do everything else….crazy. This decision to not cover total shoulder replacements in ASC’s was driven by a pro-hospital system lobby on Capitol Hill given that total shoulder replacements reimbursed hospitals at higher rates than total hip and knee replacements. At any rate, I am delighted that total shoulder replacements will now be permitted in the ambulatory surgery center and I can return to doing what I love most….taking care of patients! I will resume seeing Medicare patients normally under their insurance as I have for almost 20 years in Cleveland. It is a great day of satisfaction and vindication for all private practice orthopedic surgeons who care for shoulder patients in the United States including me.
Sincerely,
Reuben Gobezie, MD