Section A — About Your Practice These questions let AAHKS segment results (e.g., independent vs. employed, rural vs. urban, high vs. low Medicare volume). All are confidential.

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1. Which best describes your primary practice setting?

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2. In which U.S. region do you primarily practice?

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3. How would you describe the community you serve?

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4. Approximately what percentage of your total surgical volume is covered by Medicare (traditional fee-for-service plus Medicare Advantage)?

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5. Approximately how many primary Medicare total hip and total knee replacements (THA + TKA) do you personally perform per year?

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6. How many years have you been in independent practice following completion of training?

Section B — The 2027 MPFS Professional Fee Reduction Context: The CY2027 MPFS proposed rule reduces the work RVUs for primary THA and TKA (CPT 27130 / 27447) from 19.11 to about 15.9 — roughly a 16–20% work cut, beyond the RUC-recommended reduction — and lowers the conversion factor to $32.84 (non-QP). The total professional fee for a primary joint replacement is proposed to fall to roughly $922 (from about $1,159),

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7. How familiar are you with the CY2027 MPFS proposed reductions to hip and knee replacement professional fees?

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8. In your judgment, how well does the proposed professional reimbursement (~$922 per primary TJA) reflect the total work, skill, risk, and perioperative care you provide?

Section C — Medicare Patient Access These questions assess how the proposed changes may affect the number of Medicare patients you are able to treat. Full response ranges are provided; there are no right answers.

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9. If the CY2027 professional-fee reductions are finalized as proposed, how likely are you to limit the number of NEW Medicare joint-replacement patients you accept?

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10. If the reductions are finalized as proposed, by approximately how much do you expect to change the number of Medicare joint replacements you perform annually?

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11. Which of the following actions would you seriously consider in response to the proposed changes?

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12. How do you expect the proposed changes to affect Medicare patients' timely access to hip and knee replacement in your community?

Section D — Practice Economics, Overhead, and Administrative Burden Context: Under employment, practice-expense RVUs are largely absorbed by the hospital, whereas independent practices bear rising overhead and administrative requirements (prior authorization, site-of-service documentation, denials, and appeals) directly. The proposed practice-expense methodology caps year-over-year movement, and the proposed 2.5% efficiency adjustment is applied on a recurring (approximately triennial) basis.

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13. Over the past three years, how have your practice's overhead and operating costs (staff wages, supplies, rent, implants, technology) changed?

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14. If the proposed CY2027 reductions to THA/TKA professional fees and office-visit (E/M) payments are finalized, how do you anticipate your practice's staffing and administrative resources will change?

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15. In response to the proposed reduction in professional fees for primary THA/TKA and reduced payment for office visits (E/M), how do you anticipate changing your use of physician extenders (PAs / NPs)?

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16. If your practice is independent or a small business: how sustainable is it financially under the proposed professional-fee trajectory over the next 3–5 years?

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17. How would the proposed 2.5% efficiency adjustment, applied on a recurring (approximately triennial) basis, affect your long-term financial and practice planning?

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18. To what extent do the proposed changes increase pressure on you to become hospital-employed or to consolidate or sell your practice?

Section E — Mandatory Bundled Payment Models (TEAM & CJR-X) Context: TEAM (mandatory since Jan 1, 2026) wraps lower-extremity joint replacement into a 30-day episode with two-sided risk in selected areas. The proposed CJR-X model would expand mandatory 90-day bundles nationwide beginning Oct 1, 2027, placing ~2,500+ hospitals under two-sided financial risk with site-neutral target prices.

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19. How familiar are you with the mandatory TEAM model and the proposed nationwide CJR-X model?

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20. How concerned are you that mandatory two-sided-risk bundles (CJR-X), combined with reduced professional fees, will discourage you or your institution from operating on higher-risk or medically complex Medicare patients?

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21. What effect do you expect mandatory bundling to have on access to joint replacement for medically complex or socioeconomically vulnerable Medicare patients?

Section F — Workforce, Patients, and Overall Assessment

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22. How do you expect the combined CMS proposals to affect residents' and fellows' willingness to enter adult reconstruction / joint replacement?

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23. Overall, how do you expect the proposed changes to affect the quality and timeliness of care that Medicare joint-replacement patients receive?

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24. Overall, do you support or oppose the CY2027 MPFS professional-fee reductions and the expansion of mandatory bundled payment (CJR-X) as currently proposed?

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25. In your own words, what is the single greatest impact these proposed CMS changes would have on your practice, your patients, your ability to provide Medicare access or help reduce Medicare costs?

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26. How confident are you that AAHKS leadership is doing everything they can to oppose the CY2027 MPFS professional fee reductions?

Thank you. Your responses directly inform AAHKS's advocacy before CMS and Congress.

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