为整部部和膝关节关节整形手术绘制机构医疗保健支付者组合:深入了解一家大型实践机构
Nihir Parikh1, Alan Lam1, William DiCiurcio2
1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
The Journal of arthroplasty
|November 3, 2024
概括
关节整形手术 (TJA) 的数量正在增加,特别是在医疗保险患者中. 然而,每个案件的退款正在下降,这引发了对TJA提供商财务可持续性的担忧.
科学领域:
- 整形外科手术 整形外科手术
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
背景情况:
- 对全关节整形术 (THA) 和全膝关节整形术 (TKA) 的需求不断增加,推动了实践和付款人的经济负担.
- 医疗保险占全国关节整形术 (TJA) 病例的60%以上,补偿金正在恶化.
- 追踪付款人趋势对于评估实践的金融健康和可持续性至关重要.
研究的目的:
- 分析不同支付方THA和TKA患者数量,费用和支付的趋势.
- 评估支付人组合转换对骨科实践的财务影响.
- 根据当前的报销模式,评估TJA服务的可持续性.
主要方法:
- 对2019年1月至2022年12月THA和TKA案件的保险和计费索赔进行分析.
- 包括医疗保险,医疗保险优势和七个商业付款人.
- 来自新泽西州和宾夕法尼亚州机构设施的数量,费用和支付趋势.
主要成果:
- 在COVID-19流行后,TJA数量增加了医疗保险的29.1%,医疗保险优势的37.8%.
- 费用增加了超过2000万美元 (医疗保险) 和1500万美元 (医疗保险优势).
- 每个病例的支付减少了24.5% (医疗保险),18.7% (医疗保险优惠) 和15.0% (商业支付者).
结论:
- 医疗保险和医疗保险优势患者的TJA量增加意味着成本和资源使用的增加.
- 减少的支付表明医院和外科医生的补偿不足.
- 停滞不前的商业支付与医疗保险趋势相结合,引起了TJA机构的财务担忧.
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