Trends in Hospital and Surgeon Charges and Reimbursements for Revision Total Knee Arthroplasty

The relationship between surgeon and hospital charges and reimbursements for revision total knee arthroplasty (TKA) has not been well examined. The objective of this study is to report trends and variations in hospital charges and payments compared to surgeons for stage 1 (S1) vs stage 2 (S2) septic revision TKA and aseptic revision (AR) TKA.

The 5% Medicare sample was used to capture hospital and surgeon data for revision TKA from 2005 to 2014. The charge multiplier (CM) and ratio of hospital to surgeon charges, and the payment multiplier (PM) and ratio of hospital to surgeon payments were calculated. Year-to-year variation and regional trends in-patient demographics, Charlson Comorbidity Index, length of stay (LOS), CM, and PM were evaluated.

In total, 4570 AR, 1323 S1, and 863 S2 TKA patients were included. CM increased for all cohorts: 8.1-13.8 for AR (P < .001), 21.0-22.5 (P = .07) for S1, and 11.8-22.0 (P < .001) for S2. PM followed a similar trend, increasing 8.1-13.8 (P < .001) for AR, 19.8-27.3 (P = .005) for S1, and 14.7-30.7 (P < .001) for S2. Surgeon reimbursement decreased for all cohorts. LOS decreased for AR (3.8-2.8 days), S1 (12.8-6.9 days), and S2 (4.5-3.9 days). Charlson Comorbidity Index remained stable for AR patients but increased significantly for S1 and S2 cohorts.

Hospital charges and payments relative to the surgeons have significantly increased for revision TKA in the setting of stable or increasing patient complexity and decreasing LOS.