Patient Out-of-Pocket Expenses in Major Orthopedic Procedures: Total Hip Arthroplasty as a Case Study

Abstract

Total hip arthroplasty (THA) is a successful procedure for improving quality of life. There are few publications regarding out-of-pocket expenses incurred by individuals undergoing uncomplicated THA. Detailed billing and record reviews and patient phone surveys were conducted on 34 Medicare patients identifying charges and reimbursements recorded by the health care system and all out-of-pocket expenses incurred by patients undergoing uncomplicated THA (diagnostic related group [DRG] 209/current procedural terminology [CPT] 27130). Mean THA total billed charges were $46 378, 89% of that from inpatient hospitalization and 5% incurred preoperatively and 7% postoperatively. Medicare reimbursement was $14 647, supplemental reimbursement was $744, and patients paid a mean out-of-pocket expense of $758 (95% CI, 614-904; range, 102-1889). Our study supports the policy that THA remains an excellent value to both the patient and society.