Recon

Knee and Hip Replacement Costs Vary Greatly by Region — Why?

Written By: Christin L. Melton, ELS

Introduction

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are among the most common procedures patients in the United States undergo while hospitalized.[1] In 2011, US surgeons performed approximately 645,000 TKAs and 306,000 THAs, excluding revisions.[2] Data suggest that in 2015, they will perform more than 925,000 TKAs and 378,000 THAs.[3]

As the US population ages, experts anticipate that the need for TKA and THA will increase dramatically.[3] By 2020, the number of primary TKAs performed in the United States is predicted to reach almost 1.4 million and the number of THAs is expected to top 510,000.[3]

Concerned about the rapidly growing economic burden of TKAs and THAs, Blue Cross Blue Shield (BCBS) and its independent licensee Blue Health Intelligence (BHI) analyzed BCBS claims data to compare regional costs for both types of joint replacement surgery.[4]

Study Summary

Researchers for BCBS and BHI analyzed three consecutive years of claims data for BCBS health insurance subscribers 18 to 65 years of age who underwent a typical TKA or a typical hip replacement. Eligible claims were those incurred in the 36 months ending July 2013 and paid through September 2013. Claims for individuals who had concurrent Medicare coverage or who had a serious comorbidity, such as cancer or HIV, were excluded from the analysis.

The study determined the average cost of a typical total hip or knee replacement for each of 64 BCBS markets, which encompassed nearly every state in the United States. The estimated cost of each procedure included all claims stemming from the primary surgery and any claims related to presurgical and postsurgical care. In addition, BCBS-BHI analyzed differences in cost between markets and within a market.

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Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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