Seo Henry H, Shimizu Michelle R, Buddhiraju Anirudh, Afzal Sina, RezazadehSaatlou MohammadAmin, Kwon Young-Min
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Arthroplasty. 2025 Jun;40(6):1445-1451. doi: 10.1016/j.arth.2024.11.043. Epub 2024 Nov 23.
Recent changes in Medicare reimbursement policies have facilitated the shift of primary total joint arthroplasty (TJA) volume to ambulatory surgical centers (ASC). The ASCs potentially provide a more cost-effective alternative to a hospital-setting TJA. This study investigated Medicare primary TJA utilization and reimbursement trends at ASCs compared to inpatient and outpatient settings between 2019 and 2022.
Medicare Parts A and B claims data from the Centers for Medicare & Medicaid Services databases were analyzed. Primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures were identified based on respective settings and years. Billing data for ASCs, hospital outpatient departments, and inpatient TJA were compared. Monetary values were adjusted to 2022 dollars using the Consumer Price Index.
From 2019 to 2022, 1,665,237 primary TJA claims were billed (TKA 1,079,846 claims; THA 585,391 claims), with a 6.1% increase in total utilization. The volume of ASC TJAs increased by 327.1% (TKA 193.8% from 2020 to 2022; THA 61.1% from 2021 to 2022). In the same period, average reimbursement for ASC TJAs rose by 3.9% (TKA 3.4%; THA 1.3%) but showed an 8.1% decline after adjusting for inflation (TKA -8.4%; THA -6.2%). By 2022, ASCs accounted for 8.6% of the total TJAs with the lowest reimbursement per procedure (TKA $8,472.3; THA $8,578.7). This shift to ASCs corresponded with $235 million saved compared to inpatient settings and $137 million saved compared to hospital outpatient departments per year.
Our study highlights a marked increase in TJA volume at ASCs, with the procedure costing significantly less than HODP or inpatient TJAs. The findings underscore the growing acceptance of these centers as viable, cost-effective alternatives to traditional hospital settings. However, with the declining value of ASC reimbursements, continued monitoring of reimbursement policy is necessary to ensure the sustainability of ASC TJAs.
医疗保险报销政策最近的变化促使初次全关节置换术（TJA）的手术量向门诊手术中心（ASC）转移。ASC可能为医院环境下的TJA提供更具成本效益的替代方案。本研究调查了2019年至2022年期间，与住院和门诊环境相比，ASC的医疗保险初次TJA使用情况和报销趋势。
分析了医疗保险和医疗补助服务中心数据库中的医疗保险A部分和B部分索赔数据。根据各自的环境和年份确定初次全膝关节置换术（TKA）和全髋关节置换术（THA）手术。比较了ASC、医院门诊部和住院TJA的计费数据。使用消费者价格指数将货币价值调整为2022年美元。
从2019年到2022年，共开出1,665,237份初次TJA索赔账单（TKA为1,079,846份索赔；THA为585,391份索赔），总使用量增加了6.1%。ASC的TJA手术量增加了327.1%（TKA从2020年到2022年增加了193.8%；THA从2021年到2022年增加了61.1%）。同期，ASC的TJA平均报销额上升了3.9%（TKA为3.4%；THA为1.3%），但经通胀调整后下降了8.1%（TKA为-8.4%；THA为-6.2%）。到2022年，ASC占TJA总数的8.6%，每次手术的报销额最低（TKA为8,472.3美元；THA为8,578.7美元）。与住院环境相比，这种向ASC的转移每年节省了2.35亿美元，与医院门诊部相比每年节省了1.37亿美元。
我们的研究突出了ASC的TJA手术量显著增加，该手术成本明显低于医院门诊部或住院TJA。研究结果强调了这些中心作为传统医院环境可行、具成本效益替代方案的认可度不断提高。然而，随着ASC报销价值下降，有必要持续监测报销政策，以确保ASC的TJA可持续发展。
