Introduction: As inflation, new technology, and rising costs continue to strain healthcare in the United States, it is important to understand the trends in insurance reimbursement. We evaluated commercial insurance reimbursement for patients undergoing inpatient primary total knee arthroplasty (TKA) based on the technology utilized and over time. Methods: We retrospectively reviewed a commercial claims database for 33, 157 inpatient primary TKA performed with cemented or uncemented components between 1/1/2016 and 12/31/2021. All patients had private commercial insurance and procedure codes for both the hospital and physician were present. Records were reviewed for technology used and financial reimbursement, without adjusting for inflation. Independent-samples t-test and analysis of variance were performed. Results: Hospital reimbursement increased from 25, 207. 65 per TKA in 2016 to 28, 291. 10 in 2021 (p<0. 001). Physician reimbursement remained similar, from 2, 368. 25 per TKA in 2016 to 2, 279. 70 in 2021 (p=0. 1). Cemented TKA was associated with increased hospital reimbursement compared to uncemented TKA (26, 658. 98 versus 25, 854. 92, p<0. 001), but similar physician reimbursement (2, 358. 03 versus 2, 329. 60, p=0. 6). Robotic assisted (RA) cemented TKA had the higher hospital reimbursement (28, 910. 19) than manual cemented TKA (26, 342. 29), manual uncemented (25, 566. 31), and RA uncemented (26, 378. 05, p<0. 001). Physician reimbursement was similar in each of the four categories: manual cemented (2, 359. 34), manual uncemented (2, 282. 62), RA cemented (2, 348. 66), and RA uncemented (2, 414. 75, p=0. 5). Conclusion: Physician reimbursement has remained similar for primary TKA from 2016 to 2021, despite hospital reimbursement increasing. We believe that physician reimbursement should increase each year to reflect the increased cost of living caused by inflation. In addition, RA cemented primary TKA provides the highest reimbursement for both hospitals, but physicians are reimbursed similarly, independent of the technology used.
Coden et al. (Tue,) studied this question.