What’s New in Adult Reconstructive Knee Surgery

A large nationwide insurance database study revealed that net losses were greater for patients with higher Elixhauser Comorbidity Index (ECI) scores1. The U.S. Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) payment models may de-incentivize the treatment of sicker patients. As more insurance companies adopt bundled payment models such as CJR, it is important to note that Medicare risk-adjustment equations involving patient-reported outcomes cannot be applied without caution to patient-reported outcomes of commercially insured patients undergoing total knee arthroplasty (TKA). Significant differences in outcomes have been shown between Medicare and commercially insured patients when using Medicare risk-adjustment algorithms2. Although the volume of revisions has increased, the Medicare orthopaedic physician fee reimbursement for aseptic and septic TKA revision has not kept up with inflation. After adjusting for it, from 2002 to 2019, the mean aseptic revision reimbursement declined 24.83% for 2-component revision and 24.21% for 1-component revision, and septic revision reimbursement decreased even further, by 23.29% for explantation and 33.47% for reimplantation3. Lastly, it appears that the public reporting of TKA and total hip arthroplasty (THA) risk-standardized readmission and complication rates is associated with improved outcomes after the surgical procedure4.