Older TJA Medicare Patients Cost 25-59% More

How much does it cost to treat octogenarians with primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a bundled care setting as compared to younger patients aged 65-80 years?

A new study titled, “In a Bundled Payment Model, the Costs Associated With Total Joint Replacement in Those Aged Older Than 80 Years Are Significantly Greater,” tackles this question and the results are in the July 1, 2021 edition of The Journal of Arthroplasty.

Co-author Ran Schwarzkopf, M.D., M.Sc., professor of Orthopedic Surgery and associate Chief Division of Adult Reconstruction at New York University Langone Orthopedic Hospital in Manhattan pointed out that this study is first of its kind and, based on what he and this team learned, will certainly not be the last review of comparative costs of care for Medicare patients.

“This is a new topic looking within the Medicare population at different costs of joint replacement between the 80+ and younger 65-80,” said Dr. Schwarzkopf, “we show that even with equal outcomes the cost of treatment goes up, even though the reimbursement is unchanged.”

The team collected data from a retrospective review of 1,866 consecutive total joint arthroplasties (TJA) (1,225 total hips and 641 total knees) at one academic medical institution from January 2013 to December 2017. The study groups were segregated according to surgery type (elective or nonelective) and age: older (≥80 years old) or younger (65-80 years old).

When the research team looked at their data, they found that costs for the older patient group were 24.5% more than in the younger group. The team also collect data for total hip patients aged ≥90 years and found that finding that the cost difference increased to 58.7%. For older total knee patients, the cost disparity from younger patients was 17.0%. Sex, body mass index, and race did not significantly impact this cost difference.

“Even with equal outcomes patients older than 80 had significantly increased cost of care,” explained Dr. Schwarzkopf to OTW. Without a reimbursement adjustment from Medicare “this can lead surgeons and hospitals to decline treatment in this age group, even though we show their outcomes are equivalent but due to their age they may need a longer hospital stay or more help after surgery for recovery.”

“But this extra care increases the cost and within the bundled payment by CMS [the Centers for Medicare and Medicaid Services] can lead to large losses to the hospital and surgeon. Obviously, this can lead to a large access to care problem for this group of patients. CMS needs to adopt a different reimbursement scale with increased reimbursement for older patients in order to preserve equal access to care.”