Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona.
J Arthroplasty. 2024 Sep;39(9):2179-2187. doi: 10.1016/j.arth.2024.03.041. Epub 2024 Mar 22.
The purpose of this study was to evaluate changes in regional and national variations in reimbursement to arthroplasty surgeons, procedural volumes, and patient populations for total hip arthroplasty (THA) from 2013 to 2021.
The Medicare Physician and Other Practitioners database was queried for all billing episodes of primary THA for each year between 2013 and 2021. Inflation-adjusted surgeon reimbursement, procedural volume, physician address, and patient characteristics were extracted for each year. Data were stratified geographically based on the United States Census regions and rural-urban commuting codes. Kruskal-Wallis and multivariable regressions were utilized.
Between 2013 and 2021, the overall THA volume and THAs per surgeon increased at the highest rate in the West (+48.2%, +20.2%). A decline in surgeon reimbursement was seen in all regions, most notably in the Midwest (-20.3%). Between 2013 and 2021, the average number of Medicare beneficiaries per surgeon declined by 12.6%, while the average number of services performed per beneficiary increased by 18.2%. In 2021, average surgeon reimbursement was the highest in the Northeast ($1,081.15) and the lowest in the Midwest ($988.03) (P < .001). Metropolitan and rural areas had greater reimbursement than micropolitan and small towns (P < .001). Patient age, race, sex, Medicaid eligibility, and comorbidity profiles differ between regions. Increased patient comorbidities, when controlling for patient characteristics, were associated with lower reimbursement in the Northeast and West (P < .01).
Total hip arthroplasty (THA) volume and reimbursement differ between US regions, with the Midwest exhibiting the lowest increase in volume and greatest decline in reimbursement throughout the study period. Alternatively, the West had the greatest increase in THAs per surgeon. Patient comorbidity profiles differ between regions, and increased patient comorbidity is associated with decreased reimbursement in the Northeast and the West. This information is important for surgeons and policymakers as payment models regarding reimbursement for arthroplasty continue to evolve.
本研究旨在评估 2013 年至 2021 年间，髋关节置换术医生的报销、手术量和全髋关节置换术（THA）患者人群的区域和国家变化情况。
从 2013 年至 2021 年，对 Medicare 医生和其他从业人员数据库中每年所有初次 THA 的计费情况进行了查询。每年提取了调整通货膨胀后的医生报销、手术量、医生地址和患者特征。根据美国人口普查区域和城乡通勤代码，数据按地理位置进行分层。利用 Kruskal-Wallis 和多变量回归进行分析。
2013 年至 2021 年间，西部地区的 THA 总量和每位医生的 THA 数量增长最快（分别为+48.2%和+20.2%）。所有地区的医生报销均有所下降，其中中西部地区降幅最大（-20.3%）。2013 年至 2021 年间，每位医生的 Medicare 受益人数平均减少了 12.6%，而每位受益人的服务量增加了 18.2%。2021 年，东北的平均医生报销最高（1081.15 美元），中西部最低（988.03 美元）（P<0.001）。大都市和农村地区的报销高于中小城市（P<0.001）。不同地区的患者年龄、种族、性别、医疗补助资格和合并症情况存在差异。控制患者特征后，东北地区和西部地区患者合并症的增加与报销的降低相关（P<0.01）。
全髋关节置换术（THA）的数量和报销在不同的美国地区有所不同，整个研究期间，中西部地区的手术量增长最小，报销降幅最大。相比之下，西部地区每位医生的 THA 数量增长最大。不同地区的患者合并症情况不同，东北地区和西部地区患者合并症的增加与报销的降低有关。随着支付模式（包括髋关节置换术的报销）的不断发展，这些信息对医生和政策制定者来说很重要。
