Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, New York.
J Arthroplasty. 2013 Oct;28(9):1513-20. doi: 10.1016/j.arth.2013.06.001. Epub 2013 Jul 8.
We analyzed the 2009 Medicare inpatient claims data and other databases to estimate Medicare payments for primary or revision total knee arthroplasty (TKA). The average Medicare hospital payment per procedure was $13,464 for primary TKA (n=227,587) and $17,331 for revision TKA (n=18,677). For both primary and revision TKAs Medicare payments varied substantially across patients, hospitals and healthcare markets. Less than one percent of primary TKA cases but seven percent of revision TKA cases triggered Medicare "outlier" payments, which were $10,000 or higher per case beyond regular diagnosis-related-group payments. Urban and major teaching hospitals were more likely to treat these unusually expensive cases. Hospitals in the Northeast and West regions tended to receive higher Medicare payments than hospitals in the Midwest.
我们分析了 2009 年医疗保险住院索赔数据和其他数据库，以估算初次或翻修全膝关节置换术（TKA）的医疗保险支付费用。初次 TKA（n=227587）每例手术的平均医疗保险医院支付额为 13464 美元，翻修 TKA（n=18677）每例手术的平均医疗保险医院支付额为 17331 美元。初次和翻修 TKA 的医疗保险支付在患者、医院和医疗市场之间存在很大差异。初次 TKA 病例中不到 1%但翻修 TKA 病例中 7%触发了医疗保险“例外”支付，即每个病例的常规诊断相关组支付额超过 10000 美元。城市和主要教学医院更有可能治疗这些异常昂贵的病例。东北地区和西部地区的医院往往比中西部地区的医院获得更高的医疗保险支付。
