Out-of-pocket expenses for hip, knee arthroplasty expected to increase

Experts anticipate a growing discrepancy between reimbursement and hospital charges over the next decade.

SAN DIEGO — Medicare patients who become potential candidates for total hip or knee replacement in the next several years could see their out-of-pocket expenses increase substantially, according to study findings presented here at the American Academy of Orthopaedic Surgeons annual meeting.

Kevin L. Ong, PhD, a consultant from Exponent in Philadelphia, and colleagues found that the disparity between reimbursement and hospital charges through 2015 will continue to escalate. The national annual hospital charges for primary total hip arthroplasty (THA) could increase by 340% to $17.4 billion, while primary total knee arthroplasty (TKA) may go up 450% to $40.8 billion, Ong said.

Likewise, "Surgical charges are projected to increase by 180% to $1.9 billion and TKA will rise 250% to $5.1 billion," he said.

Ong and colleagues also predict a substantial rise in demand for revision hip and knee surgeries — as much as 137% and 601%, respectively, by the year 2030.

The result: Expect a much greater burden placed on Medicare and third-party dollars for these patients; the supply will not keep up with the demand, Ong said.

Overall charges for hip and knee arthroplasty procedures are expected to rise as much as 3.7- to 5.2-fold, and charges for primary THA and TKA are expected to increase over the next 10 years for all age and gender groups, he said. This could have a significant effect on hospital and orthopedic surgeon utilization, since Medicare reimbursements only average about 32% to 38% of the charges per procedure.

For more information:
Kurtz SM, Ong K, Schmier JK, et al. Future clinical and economic impact on revision THR and THA. SE39. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.