翻修全膝关节置换术的医院和外科医生收费及报销趋势。
Trends in Hospital and Surgeon Charges and Reimbursements for Revision Total Knee Arthroplasty.
机构信息
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
出版信息
J Arthroplasty. 2021 Jul;36(7S):S145-S154. doi: 10.1016/j.arth.2021.01.078. Epub 2021 Feb 5.
BACKGROUND
The relationship between surgeon and hospital charges and reimbursements for revision total knee arthroplasty (TKA) has not been well examined. The objective of this study is to report trends and variations in hospital charges and payments compared to surgeons for stage 1 (S1) vs stage 2 (S2) septic revision TKA and aseptic revision (AR) TKA.
METHODS
The 5% Medicare sample was used to capture hospital and surgeon data for revision TKA from 2005 to 2014. The charge multiplier (CM) and ratio of hospital to surgeon charges, and the payment multiplier (PM) and ratio of hospital to surgeon payments were calculated. Year-to-year variation and regional trends in-patient demographics, Charlson Comorbidity Index, length of stay (LOS), CM, and PM were evaluated.
RESULTS
In total, 4570 AR, 1323 S1, and 863 S2 TKA patients were included. CM increased for all cohorts: 8.1-13.8 for AR (P < .001), 21.0-22.5 (P = .07) for S1, and 11.8-22.0 (P < .001) for S2. PM followed a similar trend, increasing 8.1-13.8 (P < .001) for AR, 19.8-27.3 (P = .005) for S1, and 14.7-30.7 (P < .001) for S2. Surgeon reimbursement decreased for all cohorts. LOS decreased for AR (3.8-2.8 days), S1 (12.8-6.9 days), and S2 (4.5-3.9 days). Charlson Comorbidity Index remained stable for AR patients but increased significantly for S1 and S2 cohorts.
CONCLUSION
Hospital charges and payments relative to the surgeons have significantly increased for revision TKA in the setting of stable or increasing patient complexity and decreasing LOS.
背景
外科医生与医院对翻修全膝关节置换术（TKA）的收费和报销之间的关系尚未得到很好的研究。本研究的目的是报告 1 期（S1）与 2 期（S2）感染性翻修 TKA 和无菌性翻修（AR）TKA 之间医院收费和支付与外科医生之间的趋势和差异。
方法
使用 5%的医疗保险样本，从 2005 年至 2014 年，获取翻修 TKA 的医院和外科医生数据。计算收费乘数（CM）和医院与外科医生收费的比例，以及支付乘数（PM）和医院与外科医生支付的比例。评估年度变化和住院患者人口统计学、Charlson 合并症指数、住院时间（LOS）、CM 和 PM 的地区趋势。
结果
共纳入 4570 例 AR、1323 例 S1 和 863 例 S2 TKA 患者。所有队列的 CM 均增加：AR 为 8.1-13.8（P<.001），S1 为 21.0-22.5（P=.07），S2 为 11.8-22.0（P<.001）。PM 也呈现出类似的趋势，AR 增加 8.1-13.8（P<.001），S1 增加 19.8-27.3（P=.005），S2 增加 14.7-30.7（P<.001）。所有队列的外科医生报销均减少。AR（3.8-2.8 天）、S1（12.8-6.9 天）和 S2（4.5-3.9 天）的 LOS 减少。AR 患者的 Charlson 合并症指数保持稳定，但 S1 和 S2 队列的指数显著增加。
结论
在患者复杂性稳定或增加以及 LOS 减少的情况下，翻修 TKA 的医院收费和支付与外科医生相比显著增加。
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