Study finds mismatch between negotiated prices of TJA and quality of care
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Published results found inconsistencies between mean prices insurers negotiate for total joint arthroplasty and hospital-provided quality of care.
To evaluate the association between insurer-negotiated prices for TJA and CMS hospital quality measures, Thompson Zhuang MD, MBA, and colleagues analyzed publicly available data from 18 hospitals in a single, large regional health system.
According to the study, CMS quality measures included TJA-specific complication rates, readmission rates, overall clinical outcomes, patient experience, safety, process of care and efficiency. Researchers also analyzed the association between negotiated prices and the following payer insurance types: commercial in-network, commercial out-of-network, Medicare Advantage, Medicaid and discounted cash pay.
Zhuang and colleagues found the mean overall negotiated price for TJA was $54,500. They noted the lowest mean negotiated prices were with Medicare Advantage ($20,400) and Medicaid ($20,300), while the highest mean negotiated price was with out-of-network care covered by commercial insurance plans ($78,800). Researchers also found no correlation between mean negotiated prices and any CMS quality measure for any of the five payer types. With “substantial” price variation that was not accounted for by quality of care, data suggested a “mismatch between price and quality,” the researchers wrote in the study.
“This suggests efforts to better match the quality of care with TJA prices, such as matched quality and price reporting mechanisms that have been shown to increase the likelihood of patients choosing higher-value care, could improve the value of care in TJA,” the researchers wrote.
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