A review of medical claims data from 2010 to 2017 published by Blue Cross Blue Shield Association showed an increase in cost and volume of planned knee and hip replacement procedures, with knee and hip replacements rising 17% and 33%, respectively.
According to a company press release, planned orthopedic surgeries accounted for 47% of total orthopedic spending in 2017, a 44% increase from 2010. The release noted that the main cost driver was the increase in the number of knee and hip procedures during this 7-year period.
The review showed location and setting had a direct impact on total cost, with knee and hip procedures performed in an outpatient setting being significantly lower in price vs. those performed in an inpatient setting. Overall, the review showed knee and hip replacement had an average price of $30,249 and $30,685, respectively, in an inpatient setting vs. $19,002 and $22,078, respectively, in an outpatient setting. Complication rates in an outpatient setting also improved by 23% for knee procedures and by 36% for hip procedures from 2013 to 2017, according to the release. However, despite these savings, the release noted 11% of knee procedures and 8% of hip procedures were performed on an outpatient basis in 2017.
“As a leader in health care, providing coverage for one in three Americans, we know access to quality health care is important to our members, particularly as Gen X Americans — those younger than 55 [years] — are also undergoing hip and knee replacement procedures at increasing rates across the country,” Mark Talluto, vice president of strategy and analytics at Blue Cross Blue Shield Association, said in the release. “Blue Cross Blue Shield (BCBS) companies have made it a priority to provide members more tools and options to make informed decisions about the best care to meet their needs.”