What are the driving forces behind Medicare reimbursement for total joint arthroplasty? 7 key notes

Written by Eric Oliver | November 08, 2016 | Print  |

A study in The Journal of Bone & Joint Surgery presented the biggest variables affecting total joint arthroplasty reimbursement.

The study uses standard economic and healthcare specific variables.


Here is what you need to know.


1. The researchers examined 527,207 total joint arthroplasties with a weighted mean reimbursement of $14,324.84. The range of reimbursement was as low as $9,103 to as high as $38,686.


2. Total joint arthroplasty provider volume and patient satisfaction were both negatively correlated with reimbursement. Government ownership of a hospital coupled with higher Medicare costs correlated positively.


3. The researches concluded that the reimbursement rate was variable.


4. Factors associated with a high reimbursement rate include:

  • Lower patient volume
  • Lower patient satisfaction
  • A healthier patient population
  • Government ownership of a hospital


5. To prepare for value-based care, providers should expect dramatic changes in total joint reimbursement.

The following will affect reimbursement:

  • Patient volume
  • Willingness to care for sicker patient populations
  • Patient satisfaction
  • Safe outcomes
  • Procedural demand


6. Researchers examined inpatient charge or reimbursement data for 2,750 hospitals with at least 10 discharges for uncomplicated total joint arthroplasty for the 2011 fiscal year. The researchers also examined reimbursement variability using the Dartmouth Atlas.


7. The researchers said the findings need more investigation and collaboration between policymakers and providers to develop value-based reimbursement.


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