Scrutinizing Patients with Hip or Knee Replacements

Starting this year, the Centers for Medicare and Medicaid Services (CMS) is tracking hip and knee replacement readmissions as part of its Value Based Purchasing initiative. The choice of these procedures is interesting for several reasons.  As shown in Figure 1, patients most likely to have a hip or knee replaced are those 40-64 years old.1 People in that age bracket are not typical Medicare beneficiaries.

Figure 1. THR/TKR Readmissions by Age Category

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Figure 2. THR/TKR 30-Day Readmissions by Age Category

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Overall, knee replacements are nearly twice as frequent as hip replacements. Hospital readmission trends following hip replacement track age trends. More readmissions occur in the 40-64 age group than in older or younger patients. However, as Figure 2 shows, that is not the case for readmissions of patients with knee replacements. With knee surgery, patients ages 65 -74 have a greater number of readmissions. Their readmission rate is 28 percent, whereas the younger age group has a readmission rate closer to 8 percent. Hip and knee replacement procedures are costly. The average median hospital charge for a hip replacement in the Richmond area is $75,000. It is $83,0002 for knee replacement.  Cost, frequency, and the rate of readmissions are good reasons for CMS scrutiny. (11/6/2015)

1 VHHA Hip and Knee Readmission Database (2015, First Quarter)
2 VHHA PricePoint website