The Value-Based Total Joint Arthroplasty Paradox: Improved Outcomes, Decreasing Cost, and Decreased Surgeon Reimbursement, Are Access and Quality at Risk?

Abstract

Throughout the last decade, arthroplasty surgeons and hospitals have participated in and successfully navigated value-based care programs for total joint arthroplasty (TJA). United through a common goal of improving patient outcomes while reducing costs, there has been overwhelming success in reducing length of stay, emergency room visits and readmissions, and post-acute care resource utilization. Providing optimal care at a lower cost, however, has required substantial work from arthroplasty surgeons and their clinical teams outside of the initial surgical consultation and actual procedure, including perioperative medical optimization, patient education, care management and providing access for patient concerns outside of office hours. Despite surgeons' efforts, the Centers for Medicare and Medicaid Services (CMS) has continued to decrease the work Relative Value Units (wRVU) for TJA. Within this paper, we will demonstrate how surgeons have improved the value of total hip (THA) and total knee arthroplasty (TKA), and how the current trend of devaluing these highly successful procedures is unsustainable and there are concerns that this could result in reduced access to arthroplasty care for many patients.