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.
Keywords
total knee arthroplasty - TKA - Affordable Care Act - health care - socioeconomics
- Patient Protection and Affordable Care Act
