title: 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.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Belatti
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA.
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA.
authors.forename: Annunziato
authors.initials: A
authors.lastname: Amendola
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000706:statistics & numerical data; D006622:Hip Prosthesis / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007720:Knee Prosthesis / Q000191:economics* / Q000706:statistics & numerical data; D016344:Medicare Part A / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D016345:Medicare Part B / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D009985:Orthopedics / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics / Q000706:statistics & numerical data; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data; D014481:United States
keywords: economics; medicare; reimbursement; total joint arthroplasty; trends; utilization