Study: Facility costs higher for outpatient TKA vs UKA
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Despite receiving equivalent CMS reimbursement for unicompartmental knee arthroplasty performed outpatient, hospitals have increased facility costs for outpatient total knee arthroplasty, according to presented data.
“While implant cost might vary between different institutions, depending on their agreement with the manufacturers, personnel costs should be adjusted and their reimbursement should be considered appropriately,” Emanuele Chisari, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting.
Chisari and colleagues reviewed a consecutive series of 2,310 patients who had outpatient TKA and 231 patients who had outpatient unicompartmental knee arthroplasty (UKA). The surgeries were performed by 31 surgeons at two hospitals from 2018 to 2019. Patients who had a hospital stay of less than two midnights qualified as outpatients. To determine facility costs, researchers compared implant costs, medications, supplies and personnel costs between the groups using a time-driven activity-based costing algorithm.
Patients in the TKA group had higher mean implant costs ($3,403) and overall hospital costs ($6,350) when compared with patients who had UKA, which had costs of $3,081 for implants and $5,594 for overall hospital costs. TKA patients also had a greater length of stay at 1.2 days compared with 0.5 days for patients in the UKA group. Patients who had TKA had a greater postoperative personnel costs of $783 compared with $166 for patients who had UKA. Chisari said outpatient TKA, when controlled for comorbidities, was associated with an $820 mean increase in overall facility costs compared with outpatient UKA.
“Surgeons and hospitals that are in some way saving money for CMS should not be financially penalized for performing cost-effective outpatient TKA procedure when it is considered appropriate,” he said.
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Chisari E, et al. Paper 2. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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