Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Orthopedic Surgery, New York University Langone Health Medical Center, New York, NY.
J Bone Joint Surg Am. 2021 May 5;103(9):778-785. doi: 10.2106/JBJS.20.01034.
As orthopaedic physician fees continue to come under scrutiny by the U.S. Centers for Medicare & Medicaid Services (CMS), there is a continued need to evaluate trends in reimbursement rates across contemporary time intervals. Although substantially lower work relative value units (RVUs) have been previously demonstrated for septic revision total knee arthroplasty (TKA) compared with aseptic revisions, to our knowledge, there has been no corresponding analysis comparing total physician fees. Therefore, the purpose of our study was to analyze temporal trends in Medicare physician fees for septic and aseptic revision TKAs.
Current Procedural Terminology (CPT) codes related to septic 1-stage and 2-stage revision TKAs and aseptic revision TKAs were categorized. From 2002 to 2019, the facility rates of physician fees associated with each CPT code were obtained from the CMS Physician Fee Schedule Look-Up Tool. Monetary data from Medicare Administrative Contractors at 85 locations were used to calculate nationally representative means. All total physician fee values were adjusted for inflation and were translated to 2019 U.S. dollars using Consumer Price Index data from the U.S. Bureau of Labor Statistics. Cumulative annual percentage changes and compound annual growth rates (CAGRs) were computed utilizing adjusted physician fee data.
After adjusting for inflation, the total mean Medicare reimbursement (and standard deviation) for aseptic revision TKA decreased 24.83% ± 3.65% for 2-component revision and 24.21% ± 3.68% for 1-component revision. The mean septic revision TKA total Medicare reimbursement declined 23.29% ± 3.73% for explantation and 33.47% ± 3.24% for reimplantation. Both the dollar amount (p < 0.0001) and the percentage (p < 0.0001) of the total Medicare reimbursement decline for septic revision TKA were significantly greater than the decline for aseptic revision TKA.
Septic revision TKAs have been devalued at a rate greater than their aseptic counterparts over the past 2 decades. Coupled with our findings, the increased resource utilization of septic revision TKAs may result in financial barriers for physicians and subsequently may reduce access to care for patients with periprosthetic joint infections.
The devaluation of revision TKAs may result in reduced patient access to infection management at facilities unable to bear the financial burden of these procedures.
随着美国医疗保险和医疗补助服务中心（CMS）对骨科医生费用的持续审查，评估当代时间间隔内报销率的趋势仍有必要。尽管与无菌翻修相比，感染性翻修全膝关节置换术（TKA）的相对工作值单位（RVU）明显降低，但据我们所知，尚未有相应的分析比较总医师费用。因此，我们研究的目的是分析医疗保险医师对感染性和无菌性翻修 TKA 的费用的时间趋势。
将与感染性 1 期和 2 期翻修 TKA 以及无菌性翻修 TKA 相关的当前程序术语（CPT）代码进行分类。从 2002 年到 2019 年，从 CMS 医师费用时间表查询工具中获得与每个 CPT 代码相关的设施医师费用率。使用来自 Medicare 行政承包商在 85 个地点的货币数据，计算具有全国代表性的平均值。所有总医师费用值均经过通货膨胀调整，并使用美国劳工统计局的消费者价格指数数据将其转换为 2019 年的美元。利用调整后的医师费用数据计算累计年百分比变化和复合年增长率（CAGR）。
经过通货膨胀调整后，无菌性翻修 TKA 的总平均医疗保险报销（和标准差），对于 2 组件翻修降低了 24.83% ± 3.65%，对于 1 组件翻修降低了 24.21% ± 3.68%。感染性翻修 TKA 的总平均医疗保险报销，对于清创术降低了 23.29% ± 3.73%，对于再植术降低了 33.47% ± 3.24%。感染性翻修 TKA 的总医疗保险报销金额（p < 0.0001）和百分比（p < 0.0001）的下降均明显大于无菌性翻修 TKA。
在过去的 20 年中，感染性翻修 TKA 的价值降低速度超过了无菌性翻修。加上我们的发现，感染性翻修 TKA 的资源利用增加可能会给医生带来财务负担，从而可能减少患有假体周围关节感染的患者获得治疗的机会。
翻修 TKA 的贬值可能会导致无法承受这些手术财务负担的医疗机构的患者获得感染管理的机会减少。
