Hi All,

This is an interesting article;

http://www.htrnews.com/usatoday/article/57841616?odyssey=mod|newswell|text|FRONTPAGE|s

Hi Andy,

I agree with all you say, but what I find interesting and scary is this;

The researchers found the number of primary replacements among Medicare patients increased from 93,230 in 1991 to 243,802 in 2010 (an increase of 161.5%). The number of revisions increased from 9,650 to 19,871. (Here they conveniently forgot to say = 194.4%)

Also scary;
 During the same time period, length of hospital stay decreased from 7.9 days to 3.5 days for total knee replacement and from 8.9 to five days for revisions. However, re-admissions have increased slightly for total knee replacements but have increased more than 100% for revisions.
"Revisions are a much more complicated surgery,'' says Cram, "and we need to be thinking more about which patients are suited for them and which ones aren't."

If surgical techniques have increased why have re-admissions increased? (My wife says that most hospital re-admissions are for either; pain control, constipation, bladder/urinary tract infections) But why haven‘t Revision techniques increased if there is now such a demand for them?
The question I need to ask our friends across the pond is this; Is revision surgery covered by your insurance? I ask because if they are more complicated then they are bound to be more expensive, I have read that some people in the US have paid $75.000.00 for a TKR, How much will a revision cost?
I don't want to scare people, but why aren't we told about this stuff prior to surgery?

Cheers, Martin

Hello All,

That article created quite a stir at my physical therapy facility, the therapists perspective was very interesting.  I agree with Andy, I don't know how they categorize a revision.  My liner exchange was billed to my insurance company as a revision.  I just received the bills for my Total Knee Revision on 9/11, I'm not on Medicare so these charges reflect private insurance billing:
                                                                                    Hospital       $61,676 (I stayed only 2 nights, operation was almost 3 hours)
                                                                                    Surgeon        $6,888
                                                                                    Anesthesia     $2,800 (Femoral Block w/LMA - not General)

I kept all the bills for the primary TKR and the liner exchange but they are in the basement...I'm not ready to handle all those stairs quite yet.

My husband is on Medicare, the rate the doctors charge Medicare is outrageous.  As an example, he went to an orthopedists for knee pain.  The charge to Medicare for just the office visit was $675.00!  Of course Medicare paid a fraction of that and we paid almost nothing.  Why do these surgeon charge such an inflated amount when they know they will only be reimbursed so much??...because they can take the "loss" on their taxes.  So they get to keep, tax free, almost 100% of what they are reimbursed..nice set-up.

I worry that some patients are being sent home way too early and that is one of the reasons for re-admissions.  Here in the US, starting next year (I think that's the timeline) doctors reimbursement will be reduced when a patient needs to be readmitted.  I believe the hospital will also suffer a reduction in reimbursement from Medicare because of re-admission.  It's about time doctors and hospitals answer for medical errors, poor nursing care etc.  Why does the general public - who funds Medicare - have to pick-up the tab?  A friend of mine who has been a nurse for over 30 years, told me doctors always get what they want.  I'm hoping that will change.

As a side note; my recovery from this total revision has been a beast.  The worst pain is in my shin, the knee is the normal stuff.  My surgeon had to use a much longer rod in my tibia & that seems to be causing me all the shin pain.  I got a copy of my operative report and I'm amazed anyone can survive such brutality.

The future of medical care here in the US scares me, but maybe it will be better?

Diana

Diana - some serious numbers there for Private Insurance costs!

I had to go for my currency convertor to make sure they were as high as I thought they were. I used to be on Private Insurance in the UK before changing jobs and moving on to the NHS about 3 years ago.
I'm pretty sure the going rate then was about £15,000 which I think is about $24,250. This included Surgeon, Anesthetist & about 7 days hospital stay.

I haven't got the bills now but can't remember much difference between a first TKR and revision.(there may have been! my memory is not what it used to be)

Redwing - think you're right about the balance of age v TKR. Interesting that as soon as they found out I was originally on Private Insurance and not NHS. my youngish age of 44 wasn't an issue.

I also think there are many (and I was one) that couldn't have walked without a TKR at a young age - I suppose people want to enjoy life while they are young enough to do.

Would be nice if the Docs had some consistency on this - I'm not sure they do. Some have no issue with younger patients , others do