Total joint arthroplasty: trends in medicare reimbursement and implant prices

Abstract

Total joint arthroplasty (TJA) continues to be a popular target of cost control efforts. In order to provide a unique overview of financial trends facing TJA, we analyzed Medicare databases including 100% of beneficiaries, as well as industry surveys of implant list prices. Although there was a substantial increase in TJA utilization over the period 2000-2011 (+26.9%), growth has been stagnant since 2005. New coding schemes have made complicated cases more lucrative for hospitals (+2.5% to 6.5% per year), while reimbursements for uncomplicated cases have fallen (-0.7% to -0.6%). Physician reimbursements have declined on all case types (-2.5% to -2.1% per year), while list prices of orthopedic implants have risen (+4.8% to 5.5%). These trends should be kept in mind while contemplating future changes to TJA payment.

Keywords: economics; medicare; reimbursement; total joint arthroplasty; trends; utilization.