Health Affairs

From Health Affairs

Wide Variations in Knee Replacement Surgery Fees and Care

Bethesda, MD -- Knee osteoarthritis is a common ailment—and treatment is expensive: in 2008 total knee replacement inpatient costs in the United States exceeded $9 billion—the highest among the ten procedures for which demand is growing the fastest. A new study, released today as a Web First by Health Affairs, compared operating times, hospital lengths-of-stay, discharge dispositions, and in-hospital complication rates of five organizations, all members of the High Value Healthcare Collaborative. The study authors identified three key findings:

• The health system with the lowest in-hospital complication rate had brought together patients with a multispecialty team prior to the surgery, including members from anesthesiology and internal medicine to co-manage medically complex patients.
  
  
• The fastest operating times (and shortest patient stays) were at a hospital where knee replacement cases were staffed by a team of anesthesia doctors, scrub techs, and nurses specializing in arthroplasty.
  
  
• The health system that involved patients prior to surgery in their discharge planning process (and managed patient expectations about disposition after hospitalization) resulted in shorter hospitalizations.

The goal of the study was to identify opportunities to improve health care value by increasing the quality and reducing the cost of the procedure. The data consisted of 10,910 single knee replacement surgeries in 2008 and 2009 from the five health care delivery systems (Cleveland Clinic, Denver Health, Dartmouth Institute for Health Policy and Clinical Practice, Intermountain Healthcare, and Mayo Clinic). Additionally, the study found that longer hospital stays were the result of surgeries done later in the week and to older and sicker patients. Based on these results, the consortium recommends more coordinated management for medically complex patients, more use of specialized staff, and a process to improve the management of patient expectations. These innovations are being tried by the consortium’s members to evaluate whether they increase health care value.

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.

The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.