A new study published in the Journal of the American Medical Association examined the estimated difference between the purchase price and insurance payment for knee and hip replacement implants.
The study authors examined knee and hip replacements for patients under 65 years old who had private insurance. There were 40,372 total knee replacement patients and 23,570 total hip replacement patients who underwent surgery from 2011 to 2015 included in the study. The researchers found:
1. Average selling price based on data from the Orthopedic Network News was $5,023 for the knee implants. However, the average insurance payment was $10,604 for knee implants.
2. Average selling price for hip implants was $5,619.75 and the average insurance payment was $11,751 for the implants.
3. The cumulative difference between the average selling price and insurance payments for patients studied was $225.3 million for total knee replacement and $199.7 million for total hip replacement.
4. The study authors noted patient characteristics can account for a small variance in implant cost.
5. Almost half of the patients who underwent total joint replacements in 2014 were under 65 years old and younger patients are expected to account for the majority of total joint procedures over the next decade.
The study authors suggested the cost of medical devices be made publicly available, insurance companies require hospitals to identify medical devices used and hospitals be more aggressive in negotiating prices with device manufacturers in the future, according to a US News report.