J Knee Surg 2020; 33(07): 636-645
DOI: 10.1055/s-0039-1683926
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Changes in Total Knee Arthroplasty Utilization since the Implementation of ACA: An Analysis of Patient–Hospital Demographics, Costs, and Charges

Chukwuweike U. Gwam
1   Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Nequesha S. Mohamed
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Jennifer I. Etcheson
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Iciar M. Dávila Castrodad
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Jaydev B. Mistry
3   Department of Orthopaedic Surgery and Rehabiliation Medicine, SUNY Downstate Medical Center, Brooklyn, New York
,
Thea M. Recai
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Ronald E. Delanois
2   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

31 December 2018

05 February 2019

Publication Date:
25 March 2019 (online)

Abstract

The Patient Protection and Affordable Care Act (PPACA) formed the Center for Medicare and Medicaid Innovation Center which has implemented experimental reimbursement models targeted at high-demand procedures to improve care quality. However, the effect of health care reform on total knee arthroplasty (TKA) procedures has not been explored. This study explores patient–hospital level demographics, inpatient costs, and charges related to TKA procedures between 2009 and 2015. The National Inpatient Sample database was utilized to identify patients who received primary TKA between January 2009 and October 2015 (4,283,387 cases). Categorical, continuous, and ordinal data were analyzed using chi-square/Fisher's exact test, t-test/analysis of variance, or Kruskal–Wallis' test, respectively. There was an increase in proportion of TKA recipients belonging to minority groups and the lowest quartile of median income (p < 0.05). There was a 1.9% increase in recipients using Medicaid as a primary payor and volume shifts from urban nonteaching toward urban teaching hospitals. There was a reduction in mean length of stay and mean inpatient costs. There were increases in hospital charges, but reductions in rates of inpatient mortality, and other postoperative complications. TKA procedures remain the most common surgical procedure; therefore, our study assessed national trends to capture the effect of PPACA. We found an increasing proportion of TKA recipients belonging to minority and low-income groups, volume shifts to urban teaching hospitals, and lower costs of care. These findings may be useful in objectively critiquing the effects of PPACA on TKA-related care.