Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Operations Planning and Analysis, The Johns Hopkins Bayview Medical Center, Baltimore, MD.
J Arthroplasty. 2022 Sep;37(9):1715-1718. doi: 10.1016/j.arth.2022.04.006. Epub 2022 Apr 8.
In January 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the Inpatient Only (IPO) list. This study aimed to compare patient-level payments in TKA cases with a length of stay (LOS) <2 midnights before and after removal of TKA from IPO list.
In this retrospective cohort study, all Medicare patients who received a primary elective TKA from 2016-2019 with a LOS <2 midnights at an academic tertiary center were identified. Total and itemized charges and patient-level payments were compared between eligible TKA cases performed in 2016-2017 and those in 2018-2019. There were 351 eligible TKA cases identified: 151 in 2016-2017 and 200 in 2018-2019.
The percentage of patients making any out-of-pocket payment increased in 2018-2019 from 2016-2017 (51.0% versus 10.6%), as did median patient-level payment ($7.30 [range, $0.00-$3,389] versus $0.00 [range, $0.00-$1,248], P < .001 for both). A greater proportion of patients in 2018-2019 paid $1-$50 than in 2016-2017 (37.5% versus 1.3%, P < .001) with no change in the proportion of patients who made payments >$50. Total charges were less in 2018-2019 than in 2016-2017 (P = .001). Charges for drugs, laboratory tests, admissions/floor, and therapies decreased in 2018-2019, whereas charges for the operating room and radiology increased (P < .001 for all).
Patients receiving outpatient TKA in 2018-2019 were more likely to have out-of-pocket payments than patients with comparable hospital stay who were designated as inpatients, although most of these payments were less than $50.
2018 年 1 月，医疗保险和医疗补助服务中心将全膝关节置换术（TKA）从仅限住院（IPO）名单中删除。本研究旨在比较 TKA 从 IPO 名单中删除前后，住院时间（ LOS ）<2 个午夜的 TKA 病例的患者水平支付情况。
在这项回顾性队列研究中，我们确定了在学术性三级中心接受初次择期 TKA 治疗且 LOS <2 个午夜的所有 Medicare 患者。在 2016-2019 年期间，我们比较了符合条件的 TKA 病例在 2016-2017 年和 2018-2019 年期间的总费用和分项费用以及患者支付水平。共确定了 351 例符合条件的 TKA 病例：2016-2017 年 151 例，2018-2019 年 200 例。
与 2016-2017 年相比，2018-2019 年有更多的患者（51.0% 对 10.6%）进行任何自付支付，患者支付水平中位数也有所增加（$7.30 [范围：0.00-3389] 对 $0.00 [范围：0.00-1248]，两者均<0.001）。2018-2019 年，支付 1-50 美元的患者比例高于 2016-2017 年（37.5% 对 1.3%，P <0.001），而支付>50 美元的患者比例没有变化。2018-2019 年的总费用低于 2016-2017 年（P=0.001）。2018-2019 年，药物、实验室检查、入院/病房和治疗费用下降，而手术室和放射学费用增加（所有 P<0.001）。
与具有类似住院时间的被指定为住院患者相比，2018-2019 年接受门诊 TKA 治疗的患者更有可能需要自付费用，尽管这些费用大多低于 50 美元。
