An Analysis of Medicare Payment Policy for Total Joint Arthroplasty
Section snippets
Materials and Methods
A retrospective analysis of clinical, demographic, treatment, and economic data from 6483 primary and revision hip and knee arthroplasty procedures from 4 high-volume TJA centers was conducted (Table 1a, Table 1b). Patients were included in the study if they received either a primary or revision TJA from October 2005 through June 2006. Clinical factors included in the analysis were principal diagnosis on admission, APR-DRG SOI classification, presence of extensive bone loss, and surgical
Patient Demographic and Clinical Characteristics
The majority of primary and revision THA patients were women, and there were no differences in sex among procedure types, other than a significantly higher percentage of women (63%) who underwent isolated acetabular liner and femoral head exchange procedures (Table 2a, Table 2b. Similarly, the majority of primary and revision TKA patients were women, with the exception of femoral component only revisions (55% men) and tibial liner exchanges (52% men) (P < .01 for both comparisons). The average
Discussion
Medicare payment policy for lower extremity TJA procedures has evolved considerably over the past 3 years. Before 2005, all lower extremity arthroplasty procedures, regardless of patient characteristics (eg, comorbidities) or type of procedure (eg, primary vs revision), were lumped together under a single DRG (DRG 209). Previous investigators had reported significant differences in resource use between primary and revision TJA procedures 3, 4, 5, 6, 7, 8, 9, 10, 11. In October 2005, in response
Conclusions
By working with CMS to continue to evaluate policy-relevant differences in clinical characteristics and resource use among hip and knee arthroplasty patients and procedures, we recommended further refinements to the orthopedic DRGs based on differences in SOI and surgical complexity. These changes were adopted by CMS in the FY2008 Final Rule for the Inpatient Prospective Payment System. We believe these changes more closely accomplish CMS's goal of matching hospital reimbursement to resource
References (12)
CMS Changes ICD-9 and DRG codes for revision TJA
AAOS Bull
(2005)- et al.
Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study
J Arthroplasty
(2005) 2006 Hip and knee implant review
Orthop Netw News
(2006)- et al.
The hospital cost of total hip arthroplasty
J Bone Joint Surg Am
(1993) Economics of revision total hip arthroplasty
Clin Orthop
(1995)Cost analysis of revision total hip arthroplasty. A 5-year follow-up study
Clin Orthop
(1999)
Cited by (0)
Benefits or funds were received from Orthopaedic Research and Education Foundation.