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Patient out-of-pocket expenses in major orthopedic procedures: total hip arthroplasty as a case study
Daniel E Heiner1, David R Mauerhan, John L Masonis
1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
Insights
Total hip arthroplasty (THA) offers excellent value. Patients undergoing THA experience low out-of-pocket costs, averaging $758, making it a cost-effective procedure for improving quality of life.
Area of Science:
- Orthopedic Surgery
- Health Economics
Background:
- Total hip arthroplasty (THA) significantly enhances patient quality of life.
- Limited data exists on the out-of-pocket expenses associated with uncomplicated THA.
Purpose of the Study:
- To determine the total billed charges, reimbursements, and patient out-of-pocket expenses for uncomplicated THA.
- To assess the overall value of THA from patient and societal perspectives.
Main Methods:
- Retrospective review of billing records and patient phone surveys.
- Analysis of 34 Medicare patients undergoing THA (DRG 209/CPT 27130).
- Detailed examination of inpatient, preoperative, and postoperative costs and reimbursements.
Main Results:
- Mean total billed charges for THA were $46,378.
- Medicare and supplemental reimbursements totaled $15,391.
- Mean patient out-of-pocket expense was $758 (range: $102-$1,889).
Conclusions:
- THA represents a high-value procedure for patients and society.
- The financial burden on patients for uncomplicated THA is relatively low.
Abstract:
Total hip arthroplasty (THA) is a successful procedure for improving quality of life. There are few publications regarding out-of-pocket expenses incurred by individuals undergoing uncomplicated THA. Detailed billing and record reviews and patient phone surveys were conducted on 34 Medicare patients identifying charges and reimbursements recorded by the health care system and all out-of-pocket expenses incurred by patients undergoing uncomplicated THA (diagnostic related group [DRG] 209/current procedural terminology [CPT] 27130). Mean THA total billed charges were $46378, 89% of that from inpatient hospitalization and 5% incurred preoperatively and 7% postoperatively. Medicare reimbursement was $14647, supplemental reimbursement was $744, and patients paid a mean out-of-pocket expense of $758 (95% CI, 614-904; range, 102-1889). Our study supports the policy that THA remains an excellent value to both the patient and society.
