Department of Orthopedic Surgery, NYU Langone Health, New York, New York; Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S97-S102. doi: 10.1016/j.arth.2023.01.041. Epub 2023 Feb 1.
Over the past decade, reimbursement models and target payments have been modified in an effort to decrease costs of revision total knee arthroplasty (rTKA) while maintaining the quality of care. The goal of this study was to investigate trends in revenue and costs associated with rTKA.
We retrospectively reviewed all patients who underwent rTKA between 2011 and 2021 at our institution. Patients were stratified into groups based on insurance coverage: Medicare, government-managed or Medicaid (GMM), or commercial insurance. Patient demographics were collected, as well as revenue, costs, and contribution margin (CM) of the inpatient episode. Changes over time as a percentage of 2011 numbers were analyzed. Linear regressions were used to determine trend significance. In the 10-year study period, 1,698 patients were identified with complete financial data.
Overall total cost has increased significantly (P < .01). While revenues and CM for Medicare and Commercial patients remained steady between 2011 and 2021, CM for GMM patients decreased significantly (P = .01) to a low of 53.2% of the 2011 values. Since 2018, overall CM and revenues decreased significantly (P = .05, P = .01, respectively).
While from 2011 to 2018 general revenues and CM were relatively steady, since 2018 they have decreased significantly to their lowest values in over a decade for GMM and commercial patients. This trend is concerning and may potentially lead to decreased access to care. Re-evaluation of reimbursement models for rTKA may be necessary to ensure the financial viability of this procedure and prevent issues with access to care.
III.
在过去的十年中，为了降低翻修全膝关节置换术 (rTKA) 的成本，同时保持护理质量，报销模式和目标付款已进行了修改。本研究的目的是调查与 rTKA 相关的收入和成本趋势。
我们回顾性地审查了我们机构在 2011 年至 2021 年间接受 rTKA 的所有患者。根据保险类型将患者分为 Medicare、政府管理或医疗补助 (GMM) 或商业保险。收集患者的人口统计学数据，以及住院患者的收入、成本和贡献边际 (CM)。分析随时间变化的百分比。使用线性回归确定趋势的显著性。在 10 年的研究期间，确定了 1698 名具有完整财务数据的患者。
总体总成本显著增加 (P <.01)。虽然 Medicare 和商业患者的收入和 CM 在 2011 年至 2021 年期间保持稳定，但 GMM 患者的 CM 显著下降 (P =.01)，至 2011 年的 53.2%。自 2018 年以来，整体 CM 和收入显著下降 (P =.05，P =.01)。
虽然从 2011 年到 2018 年，一般收入和 CM 相对稳定，但自 2018 年以来，GMM 和商业患者的收入和 CM 已降至十年来的最低水平。这一趋势令人担忧，可能会导致获得护理的机会减少。可能需要重新评估 rTKA 的报销模式，以确保该程序的财务可行性，并防止出现获得护理的问题。
III。
