Trends in Reimbursement for All Billable Total Joint Replacement Procedures: An Analysis of the Medicare Part B Database from 2013-2021

Abstract

Introduction Total joint arthroplasty (TJA) remains highly prevalent, nearly rivaling the prevalence of other challenging conditions such as heart failure. Annually, there are over 790,000 total knee replacements and more than 450,000 hip replacements performed in the United States. As the demand for TJAs steadily increases, issues related to access, and quality have become increasingly pronounced. Despite the significant annual rise in volume of surgeries, there exists a notable gap pertaining to the epidemiology and reimbursement rates of TJAs within the United States. Methods Publicly available data from the Centers for Medicare & Medicaid Services Database was extracted. The dataset was queried to retrieve information on all TJA procedures spanning the years 2013 to 2021. Demographic and reimbursement variables were also analyzed. Furthermore, a regional analysis was performed, categorizing the data based on the United States Census regions. All monetary values in the analyses were adjusted for inflation and statistical significance was indicated by p<0.05. Results From 2013-2021 there was an overall significant increase in total beneficiaries coupled by a significant decrease in Medicare reimbursement over the same time period. Total shoulder arthroplasties had the greatest increase in beneficiaries (124.42%) and greatest decline in Medicare reimbursement (-51.23%). When stratified by region, the Northeast had the greatest mean Medicare reimbursement and the South had the greatest total beneficiaries, with reimbursement significantly declining across all regions. Conclusion With an aging United States population, the number of individuals requiring joint arthroplasty procedures is only expected to increase. The results of this study demonstrate an overall decline in reimbursement rates for TJAs coupled with increasing numbers of procedures. This may contribute to increasing strain on orthopedic surgeons and it is crucial to address the factors contributing to these trends. Future studies may seek to further clarify potential implications of this unsustainable trend and explore potential solutions.