Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA.
J Arthroplasty. 2021 Aug;36(8):2680-2684. doi: 10.1016/j.arth.2021.03.044. Epub 2021 Mar 23.
As demand for primary total joint arthroplasty (TJA) continues to grow, a proportionate increase in revision TJA (rTJA) is expected. It is essential to understand costs and reimbursement of rTJA as our country moves to bundled payment models. We aimed (1) to characterize implant and total hospital costs, (2) assess reimbursement, and (3) determine revenue for rTJA in comparison with primary TJA.
The average implant and total hospital cost of all primary and rTJA procedures by diagnosis-related group (DRG) was calculated using time-driven activity-based costing at an orthopedic hospital from 2018 to 2020. Average reimbursement and payer type were assessed by DRG. Revenue was calculated by deducting average time-driven activity-based costing total costs from reimbursement.
13,946 arthroplasties were included in the study. Implant cost comprised 55.8% of total hospital costs for rTJA DRG 468, compared with 43.6% of total hospital costs for primary TJA DRG 470. Total hospital costs for DRG 468 were 61.1% more than DRG 470. Reimbursement for rTJA was 1.23x more than primary TJA. Private payers paid 23.2% more than Medicare for rTJA. Margin for DRG 468 was 1.5% less than primary DRG 470.
rTJA requires more hospital resources and costs than primaries, yet hospital reimbursement may be inadequate with the additional expenditures necessary to provide optimal care. If hospitals cannot perform revision services under the current reimbursement model, patient access may be limited. Implant costs are a major contributor to overall rTJA cost. Strategies are needed to reduce revision implant costs to improve value of care.
Level III, economic and decision analysis.
随着对初次全关节置换术（TJA）需求的持续增长，预计翻修 TJA（rTJA）的比例也会相应增加。了解 rTJA 的成本和报销情况至关重要，因为我国正在向捆绑支付模式过渡。我们旨在：(1) 描述植入物和总医院成本；(2) 评估报销情况；(3) 与初次 TJA 相比，确定 rTJA 的收入。
使用时间驱动作业成本法，对一家骨科医院 2018 年至 2020 年的所有初次和 rTJA 手术的平均植入物和总医院成本进行了按诊断相关组（DRG）的计算。按 DRG 评估平均报销和支付类型。收入是通过从报销中扣除平均时间驱动作业成本总成本来计算的。
共纳入 13946 例关节置换术。DRG 468 的 rTJA 植入物成本占总医院成本的 55.8%，而 DRG 470 的初次 TJA 植入物成本占总医院成本的 43.6%。DRG 468 的总医院成本比 DRG 470 高 61.1%。rTJA 的报销是初次 TJA 的 1.23 倍。私人支付者为 rTJA 支付的费用比医疗保险多 23.2%。DRG 468 的利润率比主要 DRG 470 低 1.5%。
rTJA 比初次手术需要更多的医院资源和成本，但由于提供最佳护理所需的额外支出，医院的报销可能不足。如果医院在现行报销模式下无法提供翻修服务，患者的获得可能会受到限制。植入物成本是 rTJA 总成本的主要组成部分。需要采取策略来降低翻修植入物成本，以提高护理的价值。
三级，经济和决策分析。
