Medicare recipients who become candidates for total hip or total knee replacement in the next decade will likely see their out-of-pocket expenses increase according to a study presented today at the 74th Annual Meeting of the American Academy of Orthopaedic Surgeons. Medicare represents the single largest payor for hip and knee arthroplasty in the United States and this provider’s coverage decisions affect not only patients, but also surgeons, hospitals and taxpayers.

Kevin L. Ong, PhD, a managing engineer from Exponent, a consulting firm in Philadelphia, and Khaled J. Saleh, MD, associate professor of orthopaedic surgery at the University of Virginia Health system in Charlottesville, project an increasing disparity between reimbursement and hospital charges through 2015.

Researchers anticipate a massive demand for revision hip and knee surgeries in the next two decades. Hip and knee revisions are projected to grow by 137 percent and 601 percent, respectively, between 2005 and 2030. The economic consequences of the demand for hip and knee replacement surgeries are still unknown.

Overall charges for hip and knee arthroplasty procedures are expected to increase 3.7 to 5.2- fold. “This may have enormous impact on hospital and surgeon utilization, especially since Medicare reimbursements average only 32 to 38 percent of the charges per procedure,” added Dr. Ong.

Charges for primary and revision THA and TKA are projected to increase over the next decade for all age and gender groups. Women account for about two-thirds of the overall charges. The distribution of charges for the age groups differed depending on the procedure. The most elderly age group (more than 84 years) was estimated to contribute to a substantial proportion of revision THA charges. The youngest eligible Medicare patients (65-69 years) were projected to account for an increasing proportion of charges for all procedures, accounting for as much as 39.4 percent of primary TKA charges in 2015.

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