An Unsustainable Reimbursement Model: A 12-Year Analysis of Compensation for Revision Total Hip Arthroplasty

Revision total hip arthroplasty (rTHA) is a complex and resource-intensive procedure. However, physician and hospital compensations have not evolved to reflect such complexity. Therefore, we sought to describe trends in (1) physician, (2) 90-day episode-of-care, and (3) procedure type reimbursements during a 12-year period.

Using a national claims database, we identified patients who underwent aseptic or septic rTHA between 2010 and 2022 using current-procedural terminology (CPT) and international-classification-of-diseases 9/10 codes. Debridement, antibiotics, and implant retention procedures were excluded. A total of 57,821 aseptic and 17,379 septic procedures were identified. The mean dollar reimbursement was calculated each year and adjusted for inflation. Patients were grouped by insurance type: (1) Commercial, (2) Medicare-Advantage (MCR-A), and (3) Medicare (MCR). A subgroup analysis compared septic revisions based on procedure types.

Commercially insured septic procedures showed the highest increase in physician (mean difference change of $1,525.3, P < 0.001) and 90-day episode-of-care (mean difference change of $529.9, P < 0.001) reimbursements during the 12-year period. Although compared to 2010, physician reimbursement in 2022 had a slight increase in the MCR and MCR-A groups, 90-day episode-of-care reimbursement was significantly decreased (MCR mean difference change of $-2,889.3, P < 0.001; MCR-A mean difference change of $-1,601.3, P < 0.001). Regarding procedure types, single-stage and explantation had a constant slight increase in reimbursement, but aseptic revisions' and reimplantation procedures' reimbursement remained stagnant throughout the 12-year period.

Reimbursement for rTHA has remained stagnant over the past 12 years and fails to reflect increasing procedural complexity. Medicare-based plans consistently underperform compared to commercial payers, and the lack of growth in payments for aseptic and septic reimplantations threatens the sustainability of care for these patients. Urgent policy reform is needed to align reimbursement with clinical resource demands, ensure equitable compensation, and preserve patient access to this essential surgical service.