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A Perfect Storm Threatens Patient Access to Specialty Medical Care

- Unless Congress acts before the end of the month, declining reimbursement rates may force physicians to discontinue specialty services, leaving

patients with limited access to care when they need it most -

WARSAW, Ind., June 17 /PRNewswire/ -- As baby boomers approach retirement age, a confluence of forces may threaten access to the specialty care they need to treat their bone and joint disorders.

A near-epidemic level of bone and joint disorders is rapidly approaching, according to One Patient, an advocacy initiative recently launched by Biomet, Inc. a manufacturer of medical devices in Warsaw, Ind. At the same time, experts predict a shortage of physicians in general, and bone and joint specialists in particular. This shortage is likely to be worsened by declining reimbursement, which discourages physicians from focusing on specialty treatment such as joint replacement surgery for bone and joint disease.

Among the most common joint diseases, arthritis affects approximately 47 million Americans, including 50 percent of Americans over age 65. That figure is expected to grow to 67 million by 2030, according to the National Center for Health Statistics. Worse, arthritis and other bone and joint diseases are among the most expensive medical disorders: loss of earnings from disability resulting from them totaled $339 billion in 2004.

Now, as the need for specialty treatment mounts, at least three independent sources project physician shortages in the United States of between 55,000 and 200,000 by 2020. In particular, the supply of orthopaedic surgeons, specialists in treating bone and joint disorders, has grown at an average yearly rate of only 1.1 percent per 100,000 citizens for the last 10 years. To meet projected demand, the supply of orthopaedic surgeons must grow 23- 54 percent by 2020, according to the Health Resources and Services Administration.

"Patients who need total joint replacements and the surgeons who perform those procedures will be particularly hard hit," said Richard Iorio, M.D., an orthopaedic surgeon from Burlington, Mass. who has studied supply and demand issues of joint replacement surgery.

Total joint replacement involves the removal of painful arthritic joints that are replaced with high-tech implants. Approximately one million total joint replacements are performed annually in the United States, according to industry analyst reports.

Total hip and total knee replacement surgeries are prime examples. Demand for total hip replacement is expected to grow 174 percent while the demand for total knee replacement surgery is expected to grow 673 percent by 2030. Yet, of the 92 fellowship programs in the United States to train surgeons in total joint replacement, 38 percent went unfilled in 2007-08, Iorio said. Iorio attributes the shortfall to declining Medicare reimbursement policies.

"Since 1992, Medicare has cut surgeon reimbursement for joint replacement by at least 42 percent and there is no end in sight," Iorio said. "Medicare plans on cutting an additional 10.6 percent in July, followed by 5 percent in January 2009, and a total of 40 percent by 2016, and yet physician practice expenses are expected to grow over 20 percent in that time frame."

The reimbursement cuts will affect all doctors; nearly seven in 10 members surveyed by the American Medical Association said they will be forced to respond to the scheduled July cuts by either restricting Medicare treatment or discontinuing it altogether.

Congress is now working on versions of legislation which would forestall the cuts in the near term. However, Iorio says a long-term solution is needed. For more information, or to send a letter to legislators in support of preserving access to specialty care, patients, physicians and clinicians should visit

"Certainly we support a short-term measure but Medicare needs to work with the legislature to come up with a long-term solution, or it will face a shortage of trained specialists. The best and brightest will not be attracted to medicine if Medicare and other reimbursement organizations pay at rates that do not allow physicians to even cover their costs. And worse, the most vulnerable segment of our population, the elderly, who are especially hard-hit by bone and joint disease, will be hurt the most," Iorio said.

About One Patient

One Patient is an advocacy initiative of Biomet, Inc. Launched in May of 2008, its mission is to advocate for ongoing patient access to specialty care and for rational reimbursement policies which affect that access.

SOURCE Biomet, Inc.
Copyright©2008 PR Newswire.
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