Planned hip and knee replacements are on the rise in the U.S., including among younger Americans, according to an analysis from the Blue Cross Blue Shield Association (BCBSA).
Orthopedic pain costs are on the rise generally, according to the association, but one of the biggest drivers is a rise in hip and knee surgeries across nearly all ages. BCBSA’s Health of America Report reviewed medical claims data from 2010 to 2017 by BCBS Axis, representing the largest collection of commercial insurance claims data in the U.S.
Orthopedic pain conditions represent more than 14 percent of overall healthcare spending for commercially insured adults with BCBS. Planned, or elective, orthopedic procedures among BCBS members cost approximately $25 billion in 2017, about 47 percent of total orthopedic care spending. Since 2010, that cost rose 44 percent, with hip and knee procedures as the main driver.
Utilization for knee replacements rose 17 percent from 2010 to 2017, while hip replacement utilization rose 33 percent. At the same time, the price for these procedures increased 6 percent and 5 percent, respectively. The largest increase in the procedures was among 55- to 64-year-olds, though both procedures grew among younger age groups as well.
“As a leader in healthcare, 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—are also undergoing hip and knee replacement procedures at increasing rates across the country,” Mark Talluto, vice president of strategy and analytics at BCBSA, said in a statement.
As more Americans received these procedures, few were doing so in a setting where the savings can reach between 30 percent and 40 percent, according to the report.
The average price of an inpatient knee replacement is more than $30,000, while the cost of the procedure in an outpatient setting hovers around $19,000. Similarly, the inpatient cost of a hip replacement is nearly $31,000, and the cost of the procedure in the outpatient centers stands close to $22,000. In addition, outpatient complication rates improved 23 percent for knee procedures and 36 percent for hip procedures from 2013 to 2017. More importantly, the complication rates are lower than inpatient settings.
Despite these cost savings and quality improvements, only 11 percent of knee procedures and 8 percent of hip procedures were performed on an outpatient basis in 2017, according to the report.
Like other hospital procedures and services, costs of hip and knee procedures also varied by metropolitan statistical area (MSA). Among the largest 100 MSAs, a three- to four-fold difference in price point existed for an episode of care for the two surgeries. Within 30 of the largest MSAs, the price spread is greater than $25,000.
With the large variations in prices and the increase in utilization of hip and knee procedures, it is more essential for individuals to work with physicians to find a site of care that meets their needs and affordability, the report concluded.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."