Abstract：
The purpose of this study was to assess surgeon reimbursement among total joint arthroplasty (TJA) patients who had differing risk profiles within the Medicare population.
The \"2019 Medicare Physician and Other Provider\" file was utilized. In 2019, 441,584 primary total hip and knee arthroplasty procedures were billed to Medicare Part B. All episodes were included. Patient demographics and comorbidity profiles were collected for all patients. Additionally, mean patient hierarchal condition category (HCC) risk scores and physician reimbursements were collected. All procedure episodes were split into 2 cohorts; those with an HCC risk score of 1.5 or greater, and those with patient HCC risk scores less than 1.5. Variables were averaged for each cohort and compared.
The mean reimbursement across all procedures was $1,068.03. For the sicker patient cohort with a mean HCC risk score of 1.5 or greater, there was a significantly higher rate of all comorbidities compared to the cohort with HCC risk score under 1.5. The mean payment across the sicker cohort was $1,059.21, while the mean payment among the cohort with HCC risk score under 1.5 was 1,073.32 (P = .032).
This study demonstrates that for Medicare patients undergoing primary TJA in 2019, the mean surgeon reimbursement was lower for primary TJA among sick patients in comparison to their healthier counterparts, although it is difficult to ascertain the impact of this discrepancy. As alternative payment models continue to undergo evaluation and development, these data will be important for the potential advancement of more equitable reimbursement models in arthroplasty care, specifically regarding surgeon reimbursement and possible risk adjustment within such models.
The \"2019 Medicare Physician and Other Provider\" file was utilized. In 2019, 441,584 primary total hip and knee arthroplasty procedures were billed to Medicare Part B. All episodes were included. Patient demographics and comorbidity profiles were collected for all patients. Additionally, mean patient hierarchal condition category (HCC) risk scores and physician reimbursements were collected. All procedure episodes were split into 2 cohorts; those with an HCC risk score of 1.5 or greater, and those with patient HCC risk scores less than 1.5. Variables were averaged for each cohort and compared.
The mean reimbursement across all procedures was $1,068.03. For the sicker patient cohort with a mean HCC risk score of 1.5 or greater, there was a significantly higher rate of all comorbidities compared to the cohort with HCC risk score under 1.5. The mean payment across the sicker cohort was $1,059.21, while the mean payment among the cohort with HCC risk score under 1.5 was 1,073.32 (P = .032).
This study demonstrates that for Medicare patients undergoing primary TJA in 2019, the mean surgeon reimbursement was lower for primary TJA among sick patients in comparison to their healthier counterparts, although it is difficult to ascertain the impact of this discrepancy. As alternative payment models continue to undergo evaluation and development, these data will be important for the potential advancement of more equitable reimbursement models in arthroplasty care, specifically regarding surgeon reimbursement and possible risk adjustment within such models.
摘要：
目的：本研究的目的是评估医疗保险人群中风险状况不同的全关节置换术（TJA）患者的外科医生报销情况。
方法：使用了“2019年Medicare医师和其他提供者”文件。在2019年，441,584例主要的全髋关节和膝关节置换术程序被计入MedicareB部分。收集所有患者的患者人口统计学和合并症概况。此外,平均患者等级状况类别(HCC)风险评分，和医生报销被收集。所有手术发作分为两组；HCC风险评分为1.5或更高的患者，和那些与患者肝癌风险评分低于1.5。对每个队列的变量进行平均并进行比较。
结果：所有程序的平均报销额为1,068.03美元。对于平均HCC风险评分为1.5或更高的病情较重的患者队列，与HCC风险评分低于1.5的队列相比,所有合并症的发生率明显更高.整个病情加重的队列的平均支付为$1,059.21，而HCC风险评分低于1.5的队列中的平均支付为1,073.32（p=.032）。
结论：这项研究表明，对于2019年接受原发性TJA的Medicare患者，与健康患者相比，初次全关节置换术的平均外科医生报销较低。尽管很难确定这种差异的影响。随着替代支付模式的不断评估和发展，这些数据对于关节成形术护理中更公平的报销模式的潜在发展将是重要的，特别是关于外科医生报销和此类模型中可能的风险调整。
方法：使用了“2019年Medicare医师和其他提供者”文件。
结果：所有程序的平均报销额为1,068.03美元。
结论：这项研究表明，对于2019年接受原发性TJA的Medicare患者，与健康患者相比，初次全关节置换术的平均外科医生报销较低。
