美国医疗保险患者的翻修关节成形术——关节置换外科医生正在用更少的钱做更多的事情。
Revision Arthroplasty Among Medicare Patients in the United States - Arthroplasty Surgeons are Doing More for Less.
机构信息
Anne Burnett School of Medicine at Texas Christian University, Fort Worth, Texas.
Alix School of Medicine at Mayo Clinic, Scottsdale, Arizona.
出版信息
J Arthroplasty. 2024 Sep;39(9S2):S81-S87. doi: 10.1016/j.arth.2024.01.033. Epub 2024 Jan 23.
BACKGROUND
Previously documented trends of major joint arthroplasty demonstrate increasing volume and decreasing reimbursement for primary total knee and total hip arthroplasty procedures. As such, the purpose of this study was to evaluate trends in revision knee and hip arthroplasty volume and true Medicare reimbursements to physicians.
METHODS
The publicly accessible Centers for Medicare and Medicaid files were evaluated. Data were retrieved from the Part B National Summary Data File and queried for revision knee and hip arthroplasty billed to Medicare from 2000 to 2021. The total charge submitted to Medicare, Medicare reimbursement, number of revision arthroplasty surgeries performed, and average reimbursement per surgery were collected for each year. All monetary data were adjusted for inflation to 2021 dollars.
RESULTS
There were 492,360 revision total knee arthroplasty surgeries and 424,163 revision hip arthroplasty procedures billed to Medicare from 2000 to 2021. Medicare was billed a total of $919,603,674.86 for revision knee and $862,979,761.57 for revision hip arthroplasty during that time. Medicare reimbursed physicians an average of $1,499.89 per knee revision and $1,603.32 per hip revision surgery. The total volume of revision knee arthroplasty increased by 9,380 (62%) and revision hip decreased by 1,743 (9%) from the year 2000 to 2021. However, there was a decrease of average reimbursement per procedure of more than 37% ($1,987.14 to 1,254) and 39% ($2,149.87 to 1,311.17), respectively.
CONCLUSIONS
Despite a notable increase in the volume of revision total knee and stagnant revision hip arthroplasty, total billings to and reimbursements from Medicare for these procedures have not changed markedly per year. Importantly, this means that physicians are conducting more of these high-impact procedures yearly, while being reimbursed per procedure at a declining rate. This may indicate a need to re-assess billing and reimbursement rates for revision arthroplasty, in the context of the ever-increasing inflation rate.
背景
先前有研究记录了主要关节置换术的发展趋势，表明初次全膝关节和全髋关节置换术的数量不断增加，而报销金额却在不断减少。因此，本研究旨在评估膝关节和髋关节翻修手术数量的变化趋势，以及真正向医生支付的医疗保险报销金额。
方法
本研究评估了公开获取的医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）文件。从医疗保险 B 部分国家汇总数据文件中检索了从 2000 年至 2021 年期间向医疗保险报销的膝关节和髋关节翻修手术的数据。收集了每年膝关节和髋关节翻修手术的总费用、医疗保险报销金额、手术数量和每例手术的平均报销金额。所有货币数据均已根据 2021 年的通胀率进行调整。
结果
从 2000 年至 2021 年，有 492360 例膝关节翻修全膝关节置换术和 424163 例髋关节翻修全髋关节置换术向医疗保险报销。医疗保险共向膝关节翻修术报销了 919603674.86 美元，向髋关节翻修术报销了 862979761.57 美元。医疗保险向膝关节翻修术医生的平均报销金额为每例 1499.89 美元，向髋关节翻修术医生的平均报销金额为每例 1603.32 美元。膝关节翻修术的总手术量增加了 9380 例（62%），髋关节翻修术减少了 1743 例（9%）。然而，每例手术的平均报销金额却分别下降了 37%（1987.14 美元至 1254 美元）和 39%（2149.87 美元至 1311.17 美元）。
结论
尽管膝关节翻修术的数量显著增加，髋关节翻修术的数量停滞不前，但这些手术向医疗保险的总报销金额和每年的报销金额并没有明显变化。重要的是，这意味着医生每年进行的这些高影响力的手术越来越多，而每例手术的报销金额却在以递减的速度下降。这可能表明需要根据不断上升的通胀率，重新评估膝关节和髋关节翻修术的计费和报销费率。
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