Planned knee and hip replacement procedures continue to climb in cost and volume, particularly among younger Americans, according to a review of medical claims data from 2010-2017 by the Blue Cross Blue Shield Association.
Knee replacements are up by 17 percent and hip replacements are up 33 percent. Costing more than $25 billion in 2017, planned orthopedic surgeries account for 47 percent of total orthopedic spending, reflecting a 44 percent increase since 2010.
During the same time period, the average price of knee and hip procedures increased by 6 percent and 5 percent respectively.
The increase in the number of knee and hip procedures during this seven-year period is the main cost driver, as the number of such procedures has sharply risen across nearly all ages under 65.
Today, the average price for an inpatient knee replacement is $30,249, compared to $19,002 in an outpatient setting. The average cost of an inpatient hip replacement is $30,685 compared to $22,078 in an outpatient setting. That represents savings in an outpatient setting at between 30 to 40 percent.
Over a four-year period from 2013-2017, outpatient complication rates substantially improved by 23 percent for knee procedures and 36 percent for hip procedures (comparable to an inpatient setting).
Despite these potential outpatient setting savings, only 11 percent of knee procedures and 8 percent of hip procedures were performed on an outpatient basis in 2017.
Last year, the Centers for Medicare and Medicaid Services pledged to provide up to $30 million in grant funding to develop partnerships with health systems, clinicians and others to improve measures in the quality payment program of MACRA.
CMS' goal was to address measure gaps, which include orthopedic surgery. Other gap areas included pathology, radiology, mental health and substance use conditions, oncology, palliative care, and emergency medicine.