Who Pays vs Quality
In 2019 in the United States, over 400,000 total joint arthroplasty (TJA) procedures were performed. A study published in the journal of Clinical Orthopaedics and Related Research questioned TJA prices, insurers, negotiations, and quality. Negotiated prices—from commercial in- or out-of-network, cash discounted, Medicare Advantage, and Medicaid managed care—varied from $20,300 to $78,800! How varied was the quality of TJA?
The study showed:
- "substantial variation in negotiated prices for TJA across payer types in a single, large health system”
- “negotiated prices for TJA were not associated with complication or readmission rates, patient survey star rating, or hospital total performance score”
- “other market factors may be more important determinants of prices and quality”
- “Efforts to improve care value at the patient level should focus on making matched, easy-to-understand price and quality information available to patients so they can choose higher-value care”
Read the journal article.
Read the press release.
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