title: How Much Do Patients Value Total Hip and Knee Arthroplasty? A Prospective, Multicenter Study.
abstract: BACKGROUND
  With increasing health care expenditures, reform has largely focused on cost containment, particularly in elective procedures such as total hip and knee arthroplasty (THA and TKA, respectively). The primary objective of this study is to determine what financial value patients place on these highly successful procedures.
  
  
  METHODS
  An anonymous survey was administered to 670 patients at 4 different institutions (2 private practice and 2 academic centers) in the outpatient setting over a 15-month period. Patients were asked what reimbursement a surgeon should receive for a primary total joint arthroplasty (TJA), their perception of how much Medicare actually reimburses for TJA, how much they would pay out of pocket for the procedure, and their opinion of current Medicare reimbursement rates.
  
  
  RESULTS
  Of the 557 patients who participated in the survey (83% response rate), patients on average felt that orthopedic surgeons should be reimbursed $27,430 for a THA and $19,830 for a TKA. Patients would be willing to pay a significant amount of out-of-pocket costs for their procedure, mean of $14,397 for THA (50.3% of total costs) and $12,797 for TKA (46.3% of total costs). Although patients in private practice groups had higher education and household income (P < .001), patients in academic centers would be willing to pay more out-of-pocket costs ($15,922 vs $5782, P = .034 for THA, $14,419 vs $4556, P = .052 for TKA).
  
  
  CONCLUSIONS
  Patients in both private practice and academic centers feel that surgeons are underpaid for primary THA and TKA. As controversy continues to surround orthopedic surgeons' participation in Medicare, many patients are still willing to pay a significant amount of out-of-pocket expenses for TJA.
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: P Maxwell
authors.initials: PM
authors.lastname: Courtney
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mark
authors.initials: M
authors.lastname: Howard
authors.affiliation: The Anderson Orthopaedic Clinic, Alexandria, Virginia.
authors.forename: Nitin
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Orthopaedic Surgery, Division of Adult Reconstruction, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
authors.affiliation: Desert Orthopedic Center, Rancho Mirage, California.
authors.forename: Erik
authors.initials: E
authors.lastname: Schnaser
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Neil P
authors.initials: NP
authors.lastname: Sheth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000706:statistics & numerical data; D003363:Cost Control; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009985:Orthopedics / Q000191:economics* / Q000706:statistics & numerical data; D010358:Patient Participation; D010820:Physicians; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: health policy; reimbursement; total hip arthroplasty; total knee arthroplasty