Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ.
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ.
J Arthroplasty. 2021 Jul;36(7S):S134-S140. doi: 10.1016/j.arth.2020.11.035. Epub 2020 Dec 2.
Total joint arthroplasty (TJA) has been a recent target of reimbursement reform. As such, the purpose of this study was to evaluate trends in Medicare reimbursement to hospitals for TJA patients from 2011 to 2017.
The Inpatient Utilization and Payment Public Use File was queried for all primary total hip and knee arthroplasty episodes. This file includes all services billed to Medicare via the Inpatient Prospective Payment System. Extracted data included hospital charges and amount paid by Medicare. All data were adjusted for inflation to 2017 US dollars. Multiple linear mixed-model regression analyses were conducted to assess change over time, and geo-modelling was used to represent reimbursement by location.
A total of 3,368,924 primary TJA procedures were billed to Medicare by hospitals from 2011 to 2017 and included in the study. The mean inflation-adjusted Medicare payment to hospitals for DRG 469 decreased from $22,783.66 to $19,604.62 per procedure (-$3179.04; -14.0%; P < .001) and decreased from $13,290.79 to $11,771.54 for DRG 470 (-$1519.25; -11.4%, P = .011) from 2011 to 2017. Meanwhile, the mean charge submitted by hospitals increased by $6483.39 and $5115.60 for DRGs 469 and 470, respectively (+7.4% for 469, +9.3% for 470; P < .001). Medicare reimbursement to hospitals varied by state.
During the study period, the mean Medicare reimbursement to hospitals decreased for TJA from 2011 to 2017. Meanwhile, the average charge submitted by hospitals increased. As alternative payment models continue to undergo evaluation and development, these data are important for the advancement of more agreeable reimbursement models in arthroplasty care.
全关节置换术（TJA）一直是最近医保报销改革的目标。因此，本研究的目的是评估 2011 年至 2017 年 Medicare 对 TJA 患者医院报销的趋势。
查询了所有初次全髋关节和膝关节置换术的住院患者利用和支付公共使用文件。该文件包含通过住院患者预付费系统向 Medicare 报销的所有服务。提取的数据包括医院收费和 Medicare 支付的金额。所有数据均按 2017 年美元进行了通胀调整。采用多元线性混合模型回归分析评估随时间的变化，采用地理建模表示按地点报销的情况。
2011 年至 2017 年，医院向 Medicare 报销的初次 TJA 手术总计 3368924 例，纳入研究。DRG 469 的 Medicare 支付给医院的经通胀调整后的平均金额从 2011 年的 22783.66 美元降至 2017 年的 19604.62 美元（-3179.04 美元；-14.0%；P<.001），DRG 470 从 13290.79 美元降至 11771.54 美元（-1519.25 美元；-11.4%，P=.011）。与此同时，医院提交的平均费用分别增加了 6483.39 美元和 5115.60 美元，DRG 469 和 470 分别增长了 7.4%和 9.3%（DRG 469 为 6483.39 美元；DRG 470 为 5115.60 美元；P<.001）。Medicare 对医院的报销因州而异。
在研究期间，2011 年至 2017 年 Medicare 对 TJA 患者医院的平均报销金额下降。与此同时，医院提交的平均费用增加。随着替代支付模式的不断评估和发展，这些数据对于推进关节置换护理更合理的报销模式具有重要意义。
