Surgeon charges and reimbursements are declining compared with hospital payments for shoulder arthroplasty

The relationship between surgeon and hospital charges and payments for total shoulder arthroplasty (TSA) has not been well examined. The goal of this study was to report trends and variation in hospital charges and payments compared with surgeon charges and payments for TSA.

The 5% Medicare sample was used to capture hospital and surgeon charges and payments for TSA from 2005 to 2014. Two values were calculated: (1) the charge multiplier (CM), which is the ratio of hospital to surgeon charges, and (2) the payment multiplier (PM), which is the ratio of hospital to surgeon payments. The year-to-year variation and regional trends in patient demographic characteristics, Charlson Comorbidity Index, length of stay (LOS), CM, and PM were evaluated.

The study included 10,563 patients. Per-patient hospital charges increased from $33,836 to $67,177 (99.9% increase), whereas surgeon charges increased from $4284 to $4674 (9.1% increase) (the CM increased from 7.9 to 14.4, P < .0001). Hospital payments increased from $8758 to $14,167 (61.8%), whereas surgeon payments decreased from $1028 to $884 and the PM increased from 8.5 to 16.0 (P < .0001). The LOS decreased significantly (P < .0001), whereas the Charlson Comorbidity Index remained stable. Both the CM (r² = 0.931) and PM (r² = 0.9101) were strongly negatively associated with the LOS.

Hospital charges and payments relative to surgeon charges and payments have increased substantially for TSA despite stable patient complexity and a decreasing LOS. These results encourage the need for future studies with detailed cost analyses to identify the reasons for hospital and surgeon financial malalignment.