title: Effect of price capitation on implant selection for primary total hip and knee arthroplasty.
abstract: While price capitation strategies may help to control total hip (THA) and knee arthroplasty (TKA) implant costs, its effect on premium implant selection is unclear. Primary THA and TKA cases 6 months before and after capitated pricing implementation were retrospectively identified. After exclusions, 716 THA and 981 TKA from a large academic hospital and 2 midsize private practice community hospitals were reviewed. Academic hospital surgeons increased premium THA implant usage (66.5% to 70.6%; P = 0.28), while community surgeons selected fewer premium implants (36.4%) compared to academic surgeons, with no practice change (P = 0.95). Conversely, premium TKA implant usage significantly increased (73.4% to 89.4%; P < 0.001) for academic surgeons. Community surgeons used premium TKA implants at greater rates in both periods, with all cases having ≥1 premium criterion.
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mario
authors.initials: M
authors.lastname: Farías-Kovac
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Caleb R
authors.initials: CR
authors.lastname: Szubski
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Hebeish
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Kirtishri
authors.initials: K
authors.lastname: Mishra
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D002204:Capitation Fee; D004469:Economics, Hospital; D005260:Female; D006761:Hospitals; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000191:economics; D012189:Retrospective Studies; D014481:United States
keywords: implant selection; premium implants; price capitation; total hip arthroplasty; total knee arthroplasty