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reimbursement at $12,890. In addition, patients with a lower level of education gave estimates of hospital cost and reimbursement that were $7698 and $10,799 higher, respectively, than the estimates given by patients with a higher level of education (Table 5, Figure 3). Patients who were satisfied or very satisfied with their overall TJA experience estimated surgeon reimbursement at $11,673. Patients who indicated they were unsatisfied, very unsatisfied, or neutral regarding their overall experiTable 2. Distribution of Total Hip and Knee. Perceived Reimbursement and Cost Based on Responses of All Patients Parameter Mean 95% CI Median Quartile Lower Upper Lower Upper Surgeon reimbursement Implant cost Perceived Reimbursement and Cost Comparing Total Hip and Knee Arthroplasty (THA, TKA Did not reach statistical significance (P < .05). Patients’ Perceptions of the Costs of Total Hip and Knee Arthroplasty E138 The American Journal of Orthopedics® May 2015 www.amjorthopedics.com Perceived reimbursement and cost comparing total hip and knee arthroplasty (THA, TKA). Parameters marked with asterisk (*) did not reach statistical significance (P < .05). Figure 3. Perceived reimbursement and cost based on level of education. Parameters marked with asterisk (*) did not reach statistical significance (P < .05). Table 5. Perceived Reimbursement and Cost Based on Level of Education Parameter Bachelor’s Degree Mean 95% CI Median Quartile Lower Upper Lower Upper Surgeon reimbursement (P < .01) No Yes $12 Did not reach statistical significance (P < .05). J. D. Maratt et al www.amjorthopedics.com May 2015 The American Journal of Orthopedics® E139 ence gave a higher estimate of surgeon reimbursement: $14,317 (Table 6, Figure 4). Because of the small number of enrolled patients who had revision surgery and the high variability in patient responses, there were no meaningful or statistically significant differences in perceptions of cost and reimbursement based on revision or primary surgery. Patients also estimated substantial additional reimbursements to physicians for services included at no additional charge with the global surgical package. Median estimates were $300 for reimbursement to a physician making rounds in the hospital and $250 for reimbursement for an outpatient follow-up. Only 47 patients (17%) and 35 patients (12%) correctly indicated there is no additional payment for making rounds and outpatient follow-up, respectively. Estimates of these reimbursements varied by education level, procedure, and overall satisfaction (Tables 4–6). Discussion The sustainable growth rate (SGR) formula, part of the Balanced Budget Act of 1997, was constructed to manage health care costs in the context of overall economic growth. By 2001, Medicare health care expenditures had begun to outpace economic growth, and the SGR formula dictated a reduction in reimbursement to physicians. Each year over the past decade, Congress has passed legislation providing a temporary reprieve, staving off a drastic reduction of as much as 25% in 2010.6 Despite these adjustments, reimbursement continues to decrease because of overall inflation. More worrisome is that “more than half of the nearly trillion dollar price tag for expanding coverage under the Affordable Care Act (ACA) will be paid by decreasing spending for the more than 46.3 million individuals covered by Medicare.”7 ACA provisions will also create an Independent Payment Advisory Board (IPAB) to oversee health care costs and reduce Perceived reimbursement and cost based on overall satisfaction. Parameters marked with asterisk (*) did not reach statistical significance (P < .05). Table 6. Perceived Reimbursement and Cost Based on Overall Satisfaction Parameter Satisfied Mean 95% CI Median Quartile Lower Upper Lower Upper Surgeon reimbursement (Did not reach statistical significance (P < .05). Patients’ Perceptions of the Costs of Total Hip and Knee Arthroplasty E140 The American Journal of Orthopedics® May 2015 www.amjorthopedics.com Medicare spending when it is expected to exceed target levels.8 As IPAB cannot recommend increasing revenues or changing benefits, and because it is initially prohibited from recommending decreasing payments to hospitals, the decreases will likely have the greatest impact on physician reimbursement.7-9 Health care policy has been a major campaign issue during recent US elections. The public and popular media remain engaged in this important discussion. Although patients, policymakers, and physicians are understandably concerned about cost and access to health care, it is unclear if patients understand the distribution of health care cost and reimbursement. Other authors have studied patients’ perceptions of physician reimbursement for TJA. Hayden and colleagues10 surveyed 1000 residents of a Texas city. The 121 who responded to the survey thought that fair compensation for performing
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