These authors sought (1) to identify whether variation exists in total cost for different types of joint arthroplasty, and, if so, (2) to determine which cost parameters drive this variation.
They calculated the cost of the episode of inpatient care for 22,215 total joint arthroplasties by implementing time-driven activity-based costing (TDABC) at a single orthopaedic specialty hospital from 2015 to 2018. Implant price, supply costs, personnel costs, and length of stay for total knee, total hip, anatomic total shoulder, reverse total shoulder, total elbow, and total ankle arthroplasty were analyzed. Individual cost parameters were compared with total cost and volume.
Higher implant cost appeared to correlate with higher total costs and represented 53.8% of the total cost for an inpatient care cycle.
For the other implants studied, there was an inverse relationship between cost and volume. However, the cost of reverse total shoulders were substantially higher than anatomic total shoulders even though the volume of RSAs was greater than that for TSA. RSA implant costs were 17% higher than TSA implant costs, even though nearly 1.76 times as many RSAs were performed than TSAs.
The authors point out that "The high variability of implant purchase price suggests ample opportunity for cost savings. Negotiating lower implant prices, particularly for TSA, RSA, and TAA, would result in substantially lowered inpatient costs to the hospital. Previous studies have suggested that large private-practice groups and specialized hospital-physician negotiating committees would increase bargaining power and lower cost. Given the lack of cost transparency, however, further research incorporating multiple institutions is required to evaluate the efficiency of these strategies."
Comment: As the volume of RSAs continues to rise, one would hope that the implant cost would fall. This is particularly important in that the DRGs on which hospital reimbursement is based are in many cases similar for RSA and TSA. This atypical relationship between cost and volume for shoulder arthroplasties (RSA vs TSA) is also shown by the following data from Orthopaedic Network News Vol 30. No 1, January, 2019.
Note that the average selling price for RSAs is $2,558 more than TSAs.
It will be of interest to see if, with the continuing dramatic growth in use of RSA, the average selling price will fall accordingly.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
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