Hospital and Surgeon Medicare Reimbursement Trends for Total Joint Arthroplasty

Abstract

Background: Over 1 million total joint arthroplasties (TJAs) are performed every year in the United States, creating Medicare cost concerns for policy makers. The purpose of this study is to evaluate recent trends in Medicare utilization and reimbursements to hospitals/surgeons for TJAs between 2012 and 2017. Methods: We tracked annual Medicare claims and payments to TJA surgeons using publicly available Medicare databases and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization (per 10,000 Medicare beneficiaries), and reimbursement rates and to examine associations between county-specific variables and TJA utilization and reimbursements. Results: Between 2012 and 2017, there was an 18.9% increase in annual primary TJA volume (357,500 cases in 2012 to 425,028 cases in 2017) and a 2.0% increase in annual primary TJA per capita utilization (73.4 cases per 10,000 Medicare beneficiaries in 2012 to 74.8 in 2017). The Midwest and the South had higher utilization rates compared with the Northeast and West (P < .001). Utilization rates for primary TJA procedures also had a significant negative association with the poverty rate (P < .001). Medicare Part B payments to surgeons fell by 7.5%, equivalent to a 14.9% inflation-adjusted decline, whereas hospital reimbursements and charges increased by 0.3% and 18.6%, respectively, during the study period. Conclusions: Despite increasing TJA volume and utilization, surgeon reimbursements have continued to decline, whereas hospital payments and hospital charges have increased significantly more than surgeon charges. Cost containment efforts will need to address other expenditures such as hospital costs and implant costs to better align financial risks and incentives for TJA surgeons.

Medicare/Medicaid Insurance Status Is Associated With Reduced Lower Bilateral Knee Arthroplasty Utilization and Higher Complication Rates

“…1,2 As such, given the projected increases in cases, Centers for Medicare & Medicaid Services (CMS) spending on total joint arthroplasty is expected to increase to $50 billion annually. 1,2 Policies aiming to decrease Medicare/Medicaid spending have focused on total joint arthroplasty, as it is the largest expenditure paid by CMS. 3 One option that has been suggested to decrease healthcare costs is the use of simultaneous bilateral TKA (BTKA).…”

Reimbursement for Orthopaedic Surgeries in Commercial and Public Payors: A Race to the Bottom

“…1,2 Over the past decade, there has been an approximately 0.6% to 3.6% decline in inflation-adjusted payments for common orthopaedic surgical services. 2,3 These declining surgeon payments may carry unintended financial and clinical consequences affecting surgeon volume, quality of orthopaedic care, and access to care. [4][5][6] Some evidence suggests that the quality of care delivered to patients within the same hospital may vary by insurance type, with publicly insured patients demonstrating higher risk-adjusted mortality rates.…”

Hospital-Based Rapid Recovery Protocol in Knee Arthroplasty

“…Geographic variation in payments and charges must also be considered. In a recent 2020 study, the national average reimbursement per total joint arthroplasty was $12,298, with mean reimbursement higher in the Northeast ($12,844) and West ($13,453), and lower in the South ($11,627) and Midwest ($11,340) 27 .…”

“…Joint arthroplasty, in general, has seen an 18.9% increase in volume from 2012 to 2017 27 . Currently, with shared-risk payments, surgeon reimbursement continues to fall and hospital payments continue to rise.…”