15 things to know about total joint replacements

Practice Management

Here are 15 notes on total joint replacements.

Learn more about joint replacements from the experts at the Becker's 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine event, June 22-24, 2017 in Chicago. To learn more and register for the event, click here.


1. A growing number of United States residents are living with a large joint replacement. In 2014, 4.7 million people were living with an artificial knee and 2.5 million were living with an artificial hip, according to research presented at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons. By 80 years of age, the prevalence of artificial hips rises to nearly 6 percent and artificial knees rises to nearly 10 percent.


2. Total joint procedures are typically reliable and result in high reimbursement. In the United States, total knee replacements cost $28,184, as compared to $6,687 in Spain and $18,451 in the United Kingdom, according to the 2015 Comparative Price Report, by the International Federation of Health Plans. Similarly, total hip replacements cost $29,067 in the U.S., while in New Zealand and United Kingdom, the procedures average between $15,000 and $16,000.


3. A study presented at annual meeting for the American Association of Hip and Knee Surgeons in 2013, examined whether adult reconstruction surgeons who perform total joint replacements could generate an average adult reconstruction income at Medicare reimbursement rates. It shows that an AR orthopedic surgeon would earn approximately $453,618 in a Medicare-only environment, given a 33 percent contribution to overhead and benefits. A 50 percent contribution would result in a $338,521 salary.


4. A number of different factors can affect total joint replacement outcomes. For example, blood clots, specifically deep vein thrombosis and pulmonary embolism, are common complications following certain total joint replacement surgeries, and 99 percent of surgeons reported routine use of DVT and PE prevention practices for most THA/TKA patients. Around 71 percent and 79 percent of patients had not heard of DVT or PE, respectively, when the specific terms were used.


5. A recent study, published in the Journal of the American Medical Association, found a gap between the purchase price and insurance payment for knee and hip replacement implants. The cumulative difference between the average selling price and insurance payments for patients studied was $225.3 million for total knee replacement and $199.7 million for total hip replacement.


6. The number of primary and revision hip and knee arthroplasty procedures performed in the United States is expected to grow through 2030, according to a 2016 study published in the Journal of Bone and Joint Surgery.

•    Primary total hip arthroplasties are expected to grow by 174 percent by 2030.
•    Primary total knee arthroplasties are expected to grow by 673 percent by 2030.
•    Hip revision procedures are expected to double by 2026.


7. Hospitals have been charging more for prescriptions given to total joint replacement patients, according to research from Hospital Pricing Specialists. On average, daily pharmacy charges increased 22 percent from 2014 to 2015 for total joint replacement or major joint reattachment. The price of MS-DRG 470 was increased in every state except Rhode Island.


8. The increasing demand for total joint replacement procedures is driving the global hip and knee orthopedic surgical implants market, which is expected to grow at a compound annual growth rate of 9.54 percent to reach $34.57 billion by 2022, analysis by Medical Market Research shows. Zimmer Biomet is the leading player in the market.


9. In April 2016, The Joint Commission awarded its first ever Advanced Certification for Total Hip and Total Knee Replacement. Thomas Jefferson University Hospital in Philadelphia received the distinction, which shows the hospital's commitmet to providing safe and efficient care to its total hip and knee replacement patients.


10. A new area of total joint replacement procedures is the minimally invasive knee replacement procedure, according to Ortho Info. The MIS procedure  is performed through a shorter incision — 4 to 6 inches versus 8 to 10 inches for traditional knee replacements. The benefits of this procedure include less damage to soft tissues,  which leading to a quicker, less painful recovery. However, more research on the long-term function and durability of the implants is needed.


11. Several hospitals around the country are piloting bundled payment programs for total joint replacement. San Antonio-based Baptist Health System lowered expenditures on total joint procedures, without complications, by 20.8 percent after implementing a bundled payments program, according to a study published in JAMA. Expenditures for patients with complications decreased 13.8 percent from $38,537 to $33,216. The study included 3,942 patients who underwent joint replacement at the health system from July 2008 to June 2015.


12. A study, published in 2016 in Academic Emergency Medicine, found that emergency department visits are frequent following total joint replacements. Researchers studied  total joint replacement cases performed in Texas in 2011 and 2012, which would have been eligible for inclusion in CMS' new Comprehensive Care for Joint Replacement program. Of the 50,838 total joint replacement cases examined, there were 12,747 emergency department visits by 9,299 patients.


13. The Comprehensive Care for Joint Replacement model, developed by the Center for Medicare and Medicaid Innovation, went into effect on April 1, 2016, for 794 hospitals located in 67 metropolitan statistical areas throughout the country. The total Medicare payment in CJR per episode was $25,565 with 39 percent tied to post-discharge care, according to an Avalere analysis.


14. In September and October 2016, CMS released the first and second data feeds for the CJR model, respectively. DataGen, a Rensselaer, N.Y.-based healthcare data analytics and policy firm, analyzed the two feeds that offer a broad picture of comprehensive claims data for 3,660 total joint episodes between April and September 2016. According to DataGen, the aggregate spending of the 57 hospitals came in 6 percent under target.

15. CMS was set to expand the reach of its total joint replacement bundled payment program in 2017, but the Congressional Research Services issued a memo shortly after President Donald Trump took office in January, halting new regulations that had been published on the Federal Register but not implemented. The regulations were postponed for 60 days.


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