Abstract：
BACKGROUND: The purpose of this study was to assess the relationship between risk and reimbursement for both surgeons and hospitals among Medicare patients undergoing primary total joint arthroplasty (TJA).
METHODS: The \"2021 Medicare Physician and Other Provider\" and \"2021 Medicare Inpatient Hospitals\" files were used. Patient comorbidity profiles were collected, including the mean patient hierarchal condition category (HCC) risk score. Surgeon data included all primary TJA procedures (inpatient and outpatient) billed to Medicare in 2021, while hospital data included all such inpatient episodes. Surgeon and hospital reimbursements were collected. All episodes were split into a \"sicker cohort\" with an HCC risk score of 1.5 or more and a \"healthier cohort\" with HCC risk scores less than 1.5. Variables were compared across cohorts.
RESULTS: In 2021, 386,355 primary total hip and knee arthroplasty procedures were billed to Medicare and were included. The mean surgeon reimbursement among the sicker cohort was $1,021.91, which was less than for the healthier cohort of $1,060.13 (P < .001). Meanwhile, for the hospital analysis, 112,012 Medicare TJA patients were admitted as inpatients and included. The mean reimbursement to hospitals was significantly greater for the sicker cohort at $13,950.66, compared to the healthier cohort of $8,430.46. For both analyses, the sicker patient cohorts had a significantly higher rate of all comorbidities assessed (P < .001).
CONCLUSIONS: This study demonstrates that mean surgeon reimbursement was lower for primary TJA among sicker patients in comparison to their healthier counterparts, while hospital reimbursement was higher for sicker patients. This represents a discrepancy in the incentivization of care for complex patients, as hospitals receive increased remuneration for taking on extra risk, while surgeons get paid less on average for performing TJA on sicker patients. Such data should inform future policy to assure continued access to arthroplasty care among complex patients.
METHODS: The \"2021 Medicare Physician and Other Provider\" and \"2021 Medicare Inpatient Hospitals\" files were used. Patient comorbidity profiles were collected, including the mean patient hierarchal condition category (HCC) risk score. Surgeon data included all primary TJA procedures (inpatient and outpatient) billed to Medicare in 2021, while hospital data included all such inpatient episodes. Surgeon and hospital reimbursements were collected. All episodes were split into a \"sicker cohort\" with an HCC risk score of 1.5 or more and a \"healthier cohort\" with HCC risk scores less than 1.5. Variables were compared across cohorts.
RESULTS: In 2021, 386,355 primary total hip and knee arthroplasty procedures were billed to Medicare and were included. The mean surgeon reimbursement among the sicker cohort was $1,021.91, which was less than for the healthier cohort of $1,060.13 (P < .001). Meanwhile, for the hospital analysis, 112,012 Medicare TJA patients were admitted as inpatients and included. The mean reimbursement to hospitals was significantly greater for the sicker cohort at $13,950.66, compared to the healthier cohort of $8,430.46. For both analyses, the sicker patient cohorts had a significantly higher rate of all comorbidities assessed (P < .001).
CONCLUSIONS: This study demonstrates that mean surgeon reimbursement was lower for primary TJA among sicker patients in comparison to their healthier counterparts, while hospital reimbursement was higher for sicker patients. This represents a discrepancy in the incentivization of care for complex patients, as hospitals receive increased remuneration for taking on extra risk, while surgeons get paid less on average for performing TJA on sicker patients. Such data should inform future policy to assure continued access to arthroplasty care among complex patients.
摘要：
目的：本研究的目的是评估接受初次全关节置换术（TJA）的Medicare患者中外科医生和医院的风险与报销之间的关系。
方法：使用了“2021-医疗保险-医师和其他提供者”和“2021-医疗保险-住院-医院”文件。收集患者共病概况，包括平均患者等级状况类别(HCC)风险评分，这是一种考虑合并症的标准化指标。外科医生数据包括2021年向Medicare收取的所有主要TJA程序（住院和门诊），而医院数据包括2021年向Medicare收取的所有主要TJA住院事件。收集了外科医生和医院的报销。所有的发作被分成一个“病情加重队列”，HCC风险评分为1.5或更高，“健康队列”，HCC风险评分小于1.5。在队列中比较变量。
结果：2021年，向Medicare收取了386,355例初次全髋关节和膝关节置换术，并将其包括在内。在病情较重的队列中，外科医生的平均报销额为1,021.91美元，低于健康队列的1,060.13美元（P<0.001）。同时,对于医院分析，2021年，112,012名Medicare患者被接纳为原发性TJA的住院患者，并包括在内。与健康人群的8,430.46美元相比，病重人群的平均医院报销额要高得多，为13,950.66美元。对于外科医生和医院的分析，病情较重的患者队列评估的所有合并症发生率均显著较高(P<0.001).
结论：这项研究表明，与健康患者相比，在病情较重的患者中，原发性TJA的平均外科医生报销较低。而病情较重的患者的医院报销更高。这代表了对复杂患者的护理激励方面的差异，随着医院因承担额外风险而获得更多报酬，而外科医生对病情较重的患者进行TJA的平均报酬较低。这些数据应该为未来的政策提供信息，以确保复杂患者继续获得关节成形术护理。
方法：使用了“2021-医疗保险-医师和其他提供者”和“2021-医疗保险-住院-医院”文件。收集患者共病概况，包括平均患者等级状况类别(HCC)风险评分，这是一种考虑合并症的标准化指标。外科医生数据包括2021年向Medicare收取的所有主要TJA程序（住院和门诊），而医院数据包括2021年向Medicare收取的所有主要TJA住院事件。收集了外科医生和医院的报销。所有的发作被分成一个“病情加重队列”，HCC风险评分为1.5或更高，“健康队列”，HCC风险评分小于1.5。在队列中比较变量。
结果：2021年，向Medicare收取了386,355例初次全髋关节和膝关节置换术，并将其包括在内。在病情较重的队列中，外科医生的平均报销额为1,021.91美元，低于健康队列的1,060.13美元（P<0.001）。同时,对于医院分析，2021年，112,012名Medicare患者被接纳为原发性TJA的住院患者，并包括在内。与健康人群的8,430.46美元相比，病重人群的平均医院报销额要高得多，为13,950.66美元。对于外科医生和医院的分析，病情较重的患者队列评估的所有合并症发生率均显著较高(P<0.001).
结论：这项研究表明，与健康患者相比，在病情较重的患者中，原发性TJA的平均外科医生报销较低。而病情较重的患者的医院报销更高。这代表了对复杂患者的护理激励方面的差异，随着医院因承担额外风险而获得更多报酬，而外科医生对病情较重的患者进行TJA的平均报酬较低。这些数据应该为未来的政策提供信息，以确保复杂患者继续获得关节成形术护理。
