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TOTAL JOINT SECTION
15 Things to Know About Total Joint Replacements
By Anuja Vaidya
H
ere are 15 notes on total joint replacements.
1. A growing number of United States residents are living with
a large joint replacement. In 2014, 4.7 million people were liv-
ing with an artificial knee and 2.5 million were living with an artificial
hip, according to research presented at the 2014 Annual Meeting of the
American Academy of Orthopaedic Surgeons. By 80 years of age, the
prevalence of artificial hips rises to nearly 6 percent and artificial knees
rises to nearly 10 percent.
2. Total joint procedures are typically reliable and result in high reim-
bursement. In the United States, total knee replacements cost $28,184,
as compared to $6,687 in Spain and $18,451 in the United Kingdom,
according to the 2015 Comparative Price Report, by the International
Federation of Health Plans. Similarly, total hip replacements cost
$29,067 in the U.S., while in New Zealand and United Kingdom, the
procedures average between $15,000 and $16,000.
3. A study presented at annual meeting for the American Association of
Hip and Knee Surgeons in 2013, examined whether adult reconstruction
surgeons who perform total joint replacements could generate an average
adult reconstruction income at Medicare reimbursement rates. It shows
that an AR orthopedic surgeon would earn approximately $453,618 per
year in a Medicare-only environment, given a 33 percent contribution to
overhead and benefits. A 50 percent contribution would result in annual
$338,521 salary.
4. A number of different factors can affect total joint replacement out-
comes. For example, blood clots, specifically deep vein thrombosis and
pulmonary embolism, are common complications following certain total
joint replacement surgeries, and 99 percent of surgeons reported routine
use of DVT and PE prevention practices for most THA/TKA patients.
Around 71 percent and 79 percent of patients had not heard of DVT or
PE, respectively, when the specific terms were used.
5. A recent study, published in the Journal of the American Medical As-
sociation, found a gap between the purchase price and insurance pay-
ment for knee and hip replacement implants. e cumulative difference
between the average selling price and insurance payments for patients
studied was $225.3 million for total knee replacement and $199.7 mil-
lion for total hip replacement.
6. e number of primary and revision hip and knee arthroplasty proce-
dures performed in the United States is expected to grow through 2030,
according to a 2016 study published in the Journal of Bone and Joint
Surgery.
• Primary total hip arthroplasties are expected to grow by 174 per-
cent by 2030.
• Primary total knee arthroplasties are expected to grow by 673 per-
cent by 2030.
• Hip revision procedures are expected to double by 2026.
7. Hospitals have been charging more for prescriptions given to to-
tal joint replacement patients, according to research from Hospital
Pricing Specialists. On average, daily pharmacy charges increased 22
percent from 2014 to 2015 for total joint replacement or major joint
reattachment. e price of MS-DRG 470 was increased in every state
except Rhode Island.
8. e increasing demand for total joint replacement procedures is driv-
ing the global hip and knee orthopedic surgical implants market, which
is expected to grow at a compound annual growth rate of 9.54 percent
to reach $34.57 billion by 2022, an analysis by Medical Market Research
shows. Zimmer Biomet is the leading player in the market.
9. In April 2016, e Joint Commission awarded its first ever Advanced
Certification for Total Hip and Total Knee Replacement. omas
Jefferson University Hospital in Philadelphia received the distinction,
which recognizes the hospital's commitment to providing safe and ef-
ficient care to its total hip and knee replacement patients.
10. A new area of total joint replacement procedures is the minimally
invasive knee replacement procedure, according to Ortho Info. e MIS
procedure is performed through a shorter incision — 4 to 6 inches ver-
sus 8 to 10 inches for traditional knee replacements. e benefits of this
procedure include less damage to so tissues, which leads to a quicker,
less painful recovery. However, more research on the long-term function
and durability of the implants is needed.
11. Several hospitals around the country are piloting bundled payment
programs for total joint replacement. San Antonio-based Baptist Health
System lowered expenditures on total joint procedures, without compli-
cations, by 20.8 percent aer implementing a bundled payments pro-
gram, according to a study published in JAMA. Expenditures for patients
with complications decreased 13.8 percent from $38,537 to $33,216. e
study included 3,942 patients who underwent joint replacement at the
health system from July 2008 to June 2015.
12. A study, published in 2016 in Academic Emergency Medicine, found
that emergency department visits are frequently following total joint
replacements. Researchers studied total joint replacement cases per-
formed in Texas in 2011 and 2012, which would have been eligible for
inclusion in CMS' Comprehensive Care for Joint Replacement program.
Of the 50,838 total joint replacement cases examined, there were 12,747
emergency department visits by 9,299 patients.
13. e Comprehensive Care for Joint Replacement model, developed
by the Center for Medicare and Medicaid Innovation, went into effect
on April 1, 2016, for 794 hospitals located in 67 metropolitan statistical
areas throughout the country. e total Medicare payment in CJR
per episode was $25,565 with 39 percent tied to post-discharge care,
according to an Avalere analysis.
14. In September and October 2016, CMS released the first and second
data feeds for the CJR model, respectively. DataGen, a Rensselaer, N.Y.-
based healthcare data analytics and policy firm, analyzed the two feeds
that offer a broad picture of comprehensive claims data for 3,660 total
joint episodes between April and September 2016. According to Data-
Gen, the aggregate spending of the 57 hospitals came in 6 percent under
target.
15. CMS was set to expand the reach of its total joint replacement bun-
dled payment program in 2017, but the Congressional Research Servic-
es issued a memo shortly aer President Donald Trump took office in
January, halting new regulations that had been published on the Federal
Register but not implemented.
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