title: Primary Care Physician and Patient Perceptions of Reimbursement for Total Knee and Hip Replacement.
abstract: The opinions of nonspecialists and patients will be important to determining reimbursements for specialists such as orthopedic surgeons. In addition, primary care physician (PCP) perceptions of reimbursements may affect utilization of orthopedic services.
  
  
  
  We distributed a web-based survey to PCPs, asking how much they believed orthopedic surgeons were reimbursed for total hip arthroplasty (THA) and total knee arthroplasty (TKA). We also proctored a paper-based survey to postoperative patients, asking how much orthopedic surgeons should be reimbursed.
  
  
  
  There was a significant difference between perceived and actual reimbursement values for THA and TKA. Hospital-affiliated PCPs estimated higher reimbursements for both THA ($1657 vs $838, P < .0001 for Medicaid and $2246 vs $1515, P = .018 for Medicare) and TKA ($1260 vs $903, P = .052 for Medicaid and $2022 vs $1514, P = .049 for Medicare). Similarly, larger practices estimated higher reimbursements for both THA ($1861 vs $838, P < .0001 for Medicaid and $2635 vs $1515, P = .004 for Medicare) and TKA ($1583 vs $903, P = .005 for Medicaid and $2380 vs $1514, P = .011 for Medicare). Compared to PCPs, patients estimated that orthopedic surgeons should be paid 4 times higher for both THA ($9787 vs $2235, P < .0001) and TKA ($9088 vs $2134, P < .0001).
  
  
  
  PCPs believe that reimbursements for orthopedic procedures are higher than actual values. The effect that these perceptions will have on efforts at cost reform and utilization of orthopedic services requires further study.
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Wiznia
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Chang-Yeon
authors.initials: CY
authors.lastname: Kim
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Yuexin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Nishwant
authors.initials: N
authors.lastname: Swami
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Pelker
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D001291:Attitude of Health Personnel; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D019637:Orthopedic Procedures; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D011795:Surveys and Questionnaires; D014481:United States
keywords: Medicare; health care reform; joint arthroplasty; patient perception; physician perception; primary care