Distribution of High-Volume Ankle Arthroplasty Surgeons in United States Metropolitan Areas: Data from the 2012-15 Medicare Provider Utilization and Payment Release

Category: Total Ankle Arthroplasty Introduction/Purpose: Although demand for total ankle arthroplasty (TAA) is increasing, access to high-volume TAA surgeons may vary in different geographic regions. Given that low-volume TAA surgeons have demonstrated higher revision rates compared to higher-volume surgeons, access to these high-volume centers is a matter of patient and public health interest. The recent public release of the Medicare Provider Utilization and Payment Public Use File (MPUP-PUF) now allows for identification of individual providers who perform specific procedures. This study analyzed surgeon prevalence, distribution and factors that correlate with higher or lower high-volume surgeon population in metropolitan areas. Methods: The MPUP-PUF was reviewed for the 2012-2015 calendar years and data were extracted for all physicians who performed a minimum of eleven TAA procedures among traditional Medicare patients. These physicians were grouped into major metropolitan areas (population of one million or more). Average reimbursement, number of high-volume TAA surgeons and number of total procedures were calculated per major metropolitan area. The presence of an American Orthopaedic Foot and Ankle Society (AOFAS) fellowship and mean geographic reimbursement were analyzed for correlation with number of high- volume TAA surgeons. Results: The MPUP-PUF for 2012 to 2015 included 58 unique surgeons who performed a minimum of 11 TAA procedures in any of those calendar years, with a combined total 2,281 Medicare TAA procedures. Of these surgeons, 81% practice within major metropolitan areas with population greater than one million. Distribution among major metropolitan areas is highly unequal and higher numbers of surgeons are present in cities with an AOFAS fellowship. Conclusion: Access to high-volume ankle replacement surgeons among the Medicare population is lacking in multiple major metropolitan areas in the United States due to the uneven distribution of these surgeons. This method of analysis allows for opportunities to target training programs as well as placement of physicians to ensure access to high-volume ankle arthroplasty surgeons.