The Medicare Crisis: A Call to Action for Orthopaedic Surgeons

As orthopaedic surgeons, we dedicate our careers to improving the lives of our patients, many of whom rely on Medicare for their healthcare needs. The relentless series of Medicare payment cuts that we are experiencing is creating a substantial threat to our ability to provide care for our older patients. If not corrected, this problem may undermine the very foundation of our healthcare system.

The most recent challenge is a proposed 2.8 percent cut in physician pay under the 2025 Medicare physician payment schedule by the Centers for Medicare & Medicaid Services (CMS). This cut is representative of a disturbing trend that has seen Medicare payments to physicians steadily decline over the past 20 years.

To put it in perspective, all we need to do is look at reimbursement rates over the past several decades. The Medicare Physician Fee Schedule is based on a conversion factor that translates relative value units (RVUs) into payment amounts. When the Sustainable Growth Rate (SGR) formula was implemented in 1998, Medicare paid $36.69 per RVU. In 2025, the current proposal sets the conversion factor at just $32.26 per RVU. Although actual reimbursement is lower, the cost of living has risen by 80 percent over that same time frame. Additionally, surgeons have seen reductions in RVUs for commonly performed orthopaedic procedures such as total joint arthroplasty, further compounding the problem. Finally, CMS itself estimates that the Medicare Economic Index, which measures practice cost inflation, will increase by 3.6 percent in 2025. These numbers paint a clear picture of the financial challenges facing physician practices across the country. The declining value of each RVU, coupled with procedure-specific RVU reductions, is putting unprecedented financial pressure on medical practices, particularly in specialties such as orthopaedics.

The impact of these cuts is not uniform across our profession. Rural physicians, who often operate with thinner margins, are hit particularly hard. Doctors serving underserved populations, who may rely more heavily on Medicare patients, find themselves in an increasingly precarious position. Smaller practices, lacking the economies of scale of larger healthcare systems, are struggling to keep their doors open.

If this trend continues, we are facing a healthcare crisis of epic proportions. Some physicians may be forced to limit the number of Medicare patients they see, opt out of Medicare, or even close their practices. The result is reduced access to care for millions of older Americans who depend on Medicare for their healthcare needs. We are all aging, and this problem will affect all of us and our families.

We are not alone in recognizing this looming disaster. Authoritative bodies across the healthcare landscape have raised alarm bells about the long-term viability of the current Medicare payment system. The Medicare Payment Advisory Commission (MedPAC) has pointed out the unsustainable combination of an inadequate baseline payment and a lack of inflation-based updates. Medicare’s own trustees have warned that the physician payment system has failed to keep pace with the cost of practicing medicine, potentially hindering older adults’ access to healthcare.

Perhaps most concerning is the trustees’ prediction that the quality of healthcare received by Medicare beneficiaries could decline over time compared with those who have private health insurance due to the growing gap between rising costs and falling payments. These cuts may have real, potentially life-altering consequences for our patients.

So, what can be done? Fortunately, efforts are underway to reform the Medicare payment system. The Strengthening Medicare for Patients and Providers Act (H.R. 2474) has been introduced with bipartisan support. The legislation proposes to give physicians an annual, permanent inflationary payment update tied to the Medicare Economic Index. Such a change would help ensure that Medicare payments keep pace with the rising costs of providing care.

But legislative efforts alone are not enough. As orthopaedic surgeons, we need to take an active role in shaping the future of our profession and the care we provide. AAOS is at the forefront of this fight, and we must all be engaged!
Here is what we can do:

1. Get informed: Stay up to date on current and proposed Medicare policy changes. Understand the economic impact of these changes on our practices and patients. The more knowledgeable we are, the more effectively we can advocate for change.
2. Participate in advocacy efforts: We need to make our voices heard. Contact your representatives in Congress. Share your experiences and the potential impact of these cuts with patients, colleagues, and local media. Personal stories can be powerful tools in shaping public opinion and influencing policy decisions.
3. Engage with OrthoPAC: The Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC) plays a crucial role in supporting candidates who understand and prioritize healthcare issues. Consider contributing to OrthoPAC and participating in its activities. Your support can help ensure that our interests are represented in Washington, D.C.
4. Collaborate with other medical associations: The challenges we face are not unique to orthopaedic surgery. By joining forces with other medical specialties, we can present a unified voice on Medicare payment reform, increasing our influence and impact.
5. Participate in educational programs: Take advantage of AAOS-sponsored educational programs on healthcare policy and advocacy. The more we understand the complexities of healthcare policy, the better equipped we will be to effect change.
6. Engage in grassroots efforts: Sometimes the most effective advocacy happens at the local level. Participate in town halls, write letters to your local newspaper, and engage with community organizations to raise awareness about the importance of fair Medicare reimbursement.

As orthopaedic surgeons, we are accustomed to tackling complex problems and finding innovative solutions. We need to bring that same determination and problem-solving mindset to the challenge of Medicare payment reform. This issue is NOT about protecting our livelihoods—it is about ensuring that our patients and families continue to have access to the high-quality care they need and deserve. If things do not change, we risk a future where older Americans have limited access to orthopaedic care, leading to lower quality of life for millions.

But there is hope. By working together, supporting organizations such as AAOS and OrthoPAC, and actively engaging in advocacy efforts, we can impact the future of healthcare policy. We can help shape a Medicare system that ensures sustainable, high-quality care for patients by fairly compensating physicians for their expertise and costs.

Every orthopaedic surgeon has a role to play in this crucial effort to reform Medicare payments and safeguard the future of patient care. Whether it is making a phone call to your representative, contributing to OrthoPAC, or simply having a conversation with your patients about the importance of fair Medicare reimbursement, every action counts.

Together, we can ensure that Medicare beneficiaries continue to have access to the high-quality orthopaedic care they need. The future of our profession and the health of our patients depend on our actions today. Let’s rise to the challenge and make our voices heard. The health of our nation’s seniors—and the future of orthopaedic care—hang in the balance.

The Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC) is affiliated with and connected to the 501(c)(6) Association. OrthoPAC is not connected to or affiliated with the American Academy of Orthopaedic Surgeons, which is a 501(c)(3) organization.

Paul Tornetta III, MD, PhD, FAAOS, is the 2024–2025 AAOS president and the director of orthopaedic trauma at Boston Medical Center. He is also professor and chair of the Department of Orthopaedic Surgery at the Chobanian & Avedisian School of Medicine of Boston University.