These factors impact knee replacement costs: 5 observations

Practice Management

A Medscape study found comorbidities aren't the only cost-increasing factors in knee replacement surgeries.

Here are five things to know:


1. Big drivers of cost are individual payment plans, hospital contracts and individual states. Fee-for-service reimbursement creates an incentive for over-treatment and causes CMS to ask medical centers to accept lump payments for episodes of care.


2. Many orthopedic surgeons believe patients at a higher risk for complications should pay more for treatment. David Fisher, MD, of Indianapolis-based OrthoIndy said in the report, "The concern is that we start rationing care and not providing procedures to high-risk patients."


3. Researchers found longer hospital stays, discharge to a skilled nursing facility and complications all increased cost but altogether only made up 14 percent of the total cost among privately insured patients. Those looking for cost-reduction strategies should focus on what goes on in hospitals.


4. Some practices believe bundled payments are the way to go. Charlotte, N.C.-based OrthoCarolina saves $2,700 per case, reducing skilled nursing facility admissions by 6 percent, home health usage by 6 percent and dropping readmission rates from 12 percent to 10 percent, due to its bundled payments program. 


5. Many medical practices could deny patients if CMS doesn't have a risk-stratification program to refer them to appropriate facilities aimed at improving their overall health before any type of surgery.


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