New Medicare Rules Change Pay for Bone and Spine Surgery

Many bone and spine surgeons who treat Medicare patients now face new payment rules. A program called the Transforming Episode Accountability Model started on January 1, 2026. It involves about 741 hospitals across 188 regions. The program covers five surgery types, including hip and knee replacements and spinal fusions.

A second plan, the Expanded Comprehensive Care for Joint Replacement Model, could roll out across the country by 2028. Doctors who mainly treat children or people without Medicare do not have direct contact with these specific programs. Adult orthopaedic teams, however, need to understand what is coming.

Federal officials have also set a rule about patient feedback. Beginning in 2028, hospitals must gather survey results from most patients before and one year after elective hip or knee replacement surgery. This data can affect hospital payments. Similar measures may arrive for spine and other adult bone procedures later. Children's orthopaedic practices are not included in this rule right now.

Before signing value-based contracts, doctors should ask who decides how savings are shared and how risk is calculated. They should also have authority over surgery protocols and implant choices. Studies show that when physicians help lead the process, results improve for both health and money. Early bundled programs saved cash mostly by cutting care after hospital discharge, while using complication and readmission rates as safety checks. Hospitals and doctors must balance saving money with keeping patients safe.

Readers might wonder what value actually means. Is it only about lowering costs? Or is it about helping people recover and live better? These questions matter as payment rules keep changing for adult bone and spine care. Thinking critically about these rules can help patients and doctors make smarter choices.