TUESDAY, Dec. 27, 2022 (HealthDay News) — The overall negotiated price for total joint arthroplasty (TJA) varies considerably for hospitals within a regional health system and prices are not associated with measures of hospital quality, such as complication or readmission rates, according to a study published online Dec. 13 in Clinical Orthopaedics and Related Research.
Thompson Zhuang, M.D., from Stanford University in Redwood City, California, and colleagues analyzed data from 22 hospitals in a large regional health system to assess how prices insurers negotiate for TJA vary across payer types. For each hospital, negotiated prices for TJA were classified into five payer types.
The researchers found that the mean overall negotiated price for TJA was $54,500 ± 23,200. The lowest negotiated prices were associated with Medicare Advantage and Medicaid insurance plans ($20,400 ± 1,800 and $20,300 ± 8,600, respectively) in the descriptive analysis, and the highest prices were seen in association with out-of-network care covered by commercial insurance plans ($78,800 ± 9,200). No association was seen for any of the payer types evaluated between the mean negotiated price and TJA complication rate, readmission rate, patient survey star rating, or total hospital performance score.
“Other market factors may be more important determinants of prices and quality,” the authors write. “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.”
One author disclosed payment for expert testimony from health insurance companies. One author disclosed financial ties to the pharmaceutical and medical device industries.
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