Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Hospital for Joint Diseases, New York University Langone Orthopedic Hospital, New York, NY.
J Bone Joint Surg Am. 2021 Jul 7;103(13):1212-1219. doi: 10.2106/JBJS.20.01643.
BACKGROUND: Investigations into reimbursement trends for primary and revision arthroplasty procedures have demonstrated a steady decline over the past several years. Revision total hip arthroplasty (rTHA) due to infection (rTHA-I) has been associated with higher resource utilization and complexity, but long-term inflation-adjusted data have yet to be compared between rTHA-I and rTHA due to aseptic complications (rTHA-A). The present study was performed to analyze temporal reimbursement trends regarding rTHA-I procedures compared with those for rTHA-A procedures. METHODS: The Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool was used to extract Medicare reimbursements associated with 1-stage and 2-stage rTHA-I as well as 1-stage rTHA-A procedures from 2002 to 2019. Current Procedural Terminology (CPT) codes for rTHA were grouped according to the American Academy of Orthopaedic Surgeons coding reference guide. Monetary values were adjusted for inflation using the consumer price index (U.S. Bureau of Labor Statistics; reported as 2019 U.S. dollars) and used to calculate the cumulative and average annual percent changes in reimbursement. RESULTS: Following inflation adjustment, the physician fee reimbursement for rTHA-A decreased by a mean [and standard deviation] of 27.26% ± 3.57% (from $2,209.11 in 2002 to $1,603.20 in 2019) for femoral component revision, 27.41% ± 3.57% (from $2,130.55 to $1,542.91) for acetabular component revision, and 27.50% ± 2.56% (from $2,775.53 to $2,007.61) for both-component revision. Similarly, for a 2-stage rTHA-I, the mean reimbursement declined by 18.74% ± 3.87% (from $2,063.36 in 2002 to $1,673.36 in 2019) and 24.45% ± 3.69% (from $2,328.79 to $1,755.45) for the explantation and reimplantation stages, respectively. The total decline in physician fee reimbursement for rTHA-I ($1,020.64 ± $233.72) was significantly greater than that for rTHA-A ($580.72 ± $107.22; p < 0.00001). CONCLUSIONS: Our study demonstrated a consistent devaluation of both rTHA-I and rTHA-A procedures from 2002 to 2019, with a larger deficit seen for rTHA-I. A continuation of this trend could create substantial disincentives for physicians to perform such procedures and limit access to care at the population level. LEVEL OF EVIDENCE: Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景:对初次关节置换和翻修手术的报销趋势进行的调查显示,过去几年这一趋势一直呈稳步下降。由于感染而进行的翻修全髋关节置换术(rTHA-I)与更高的资源利用率和复杂性相关,但长期通胀调整数据尚未在 rTHA-I 和因无菌性并发症而进行的翻修全髋关节置换术(rTHA-A)之间进行比较。本研究旨在分析与 rTHA-A 手术相比,rTHA-I 手术的时间报销趋势。
方法:使用医疗保险和医疗补助服务中心(CMS)医师费用表查询工具,从 2002 年至 2019 年,提取与 1 期和 2 期 rTHA-I 以及 1 期 rTHA-A 手术相关的 Medicare 报销。rTHA 的当前程序术语(CPT)代码根据美国骨科医师协会编码参考指南进行分组。使用消费者物价指数(美国劳工统计局;报告为 2019 年美元)调整货币价值的通胀,并用于计算报销的累计和年度百分比变化。
结果:经过通胀调整后,rTHA-A 的医师费用报销平均下降了 27.26%±3.57%(从 2002 年的 2209.11 美元降至 2019 年的 1603.20 美元),股骨部件翻修下降了 27.26%±3.57%,髋臼部件翻修下降了 27.41%±3.57%(从 2130.55 美元降至 1542.91 美元),双部件翻修下降了 27.50%±2.56%(从 2775.53 美元降至 2007.61 美元)。同样,对于 2 期 rTHA-I,平均报销下降了 18.74%±3.87%(从 2002 年的 2063.36 美元降至 2019 年的 1673.36 美元),2 期 rTHA-I 的植入和再植入阶段分别下降了 24.45%±3.69%(从 2328.79 美元降至 1755.45 美元)。rTHA-I 的医师费用报销总降幅(1020.64±233.72 美元)明显大于 rTHA-A(580.72±107.22 美元;p<0.00001)。
结论:我们的研究表明,从 2002 年到 2019 年,rTHA-I 和 rTHA-A 手术都出现了一致的贬值,rTHA-I 的降幅更大。如果这种趋势持续下去,可能会对医生进行此类手术造成实质性的抑制,并限制在人群层面获得护理的机会。
证据水平:经济和决策分析四级。有关证据水平的完整描述,请参见作者说明。
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