Study: Insurers paid double for hip and knee implants

Health insurers essentially paid double the price for hip and knee implants over a 5-year period, according to a study published this week in the Journal of the American Medical Assn.

Researchers at Boston’s Childrens Hospital culled statistics on total knee arthroplasties and total hip arthroplasties from the de-identified database of some 45 million patients belonging to a “nationwide, private health insurance plan,” according to the study. They culled claims data for 40,372 TKA patients and 23,570 THA patients from 2011 to 2015 and correlated that with average selling prices obtained from Orthopedic Network News and ECRI Institute’s PriceGuide.

The average selling price for TKAs was $5,023, compared with a mean insurance payment of $10,604.52, the study found; in hips, the ASP for THAs was $5,619.75, compared with a mean insurance payment of $11,751.25.

That means the difference between what hospitals and insurers paid over the 5 years was $225.3 million for total knee arthroplasties and $199.7 million for total hip arthroplasties, for a total of $425 million or $85 million annually.

“The total payments insurance companies pay for knee and hip implants were twice as high as the average selling prices at which hospitals purchased the implants from manufacturers, resulting in hundreds of millions of dollars of additional insurance claims,” the researchers wrote.

The study was limited by a few factors, including that the national insurers beneficiaries were not nationally representative. The results for publicly insured patients could differ, they wrote, and the study excluded patients older than 65. The price and payment estimates also might not correspond to prices paid by other hospitals and insurers, public and private, they wrote.

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