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    ICJR ABSTRACTS: Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty

    At the 7th Annual ICJR South Hip & Knee Course, 6 awards were given to orthopaedic residents and fellows who submitted the best research abstracts in hip and knee replacement. The abstract Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty received the Best Design Award: Knee Arthroplasty and was presented by Nicole Durig Quinlan, MD, MS.

    RELATED: Register for the 8th Annual ICJR South Hip & Knee Course

    Authors

    Brian C. Werner, MD; Nicole D. Quinlan, MD, MS; Dennis Q. Chen, MD; and James A. Browne, MD

    Background

    The incidence of total joint arthroplasty procedures performed in the U.S. continues to rise, increasing the economic burden on the healthcare system. In an effort to minimize this burden, surgeons and hospitals are tasked with providing high quality patient care efficiently while minimizing costs and unnecessary services. The aim of this study was to analyze the trend in hospital charges and payments adjusted to corresponding surgeon charges and payments in a Medicare population for total hip and knee arthroplasty.

    Methods

    Using a national insurance database, a 5% Medicare sample population was used to capture hospital and surgeon charges and payments related to primary total hip and knee arthroplasty for all indications between 2005 and 2014. For each procedure, the hospital to surgeon cost ratio and hospital to surgeon payment ratio was obtained and compared across each year and between geographic regions, including trends in patient profiles, length of stay and Charlton comorbidity index.

    Results

    A total of 56,228 THA and 117,698 TKA patients were included. The hospital had significantly higher charges (p<0.0001) and payments (p<0.0001) compared to the surgeon for the study period with a significant inverse correlation to hospital length of stay. Patient medical complexity remained unchanged over time for each cohort. Regional variation existed in hospital charges and payments relative to the surgeon. Substantial differences in hospital charge ratios were found between geographical regions in both cohorts.

    Conclusion

    Surgeon costs and reimbursements remained unchanged while hospital charges and reimbursements substantially increased, despite decreasing hospital length of stay and unchanged patient medical complexity over time.

    Click the image above to watch Dr. Quinlan’s presentation of this Best Design Award-winning abstract.

    Author Information

    Brian C. Werner, MD; Nicole D. Quinlan, MD, MS; Dennis Q. Chen, MD; and James A. Browne, MD, are from the Department of Orthopaedic Surgery at the University of Virginia Health System in Charlottesville.