The number of total joint arthroplasties being performed in the United States continues to grow1-3. Current estimates are that approximately 512,000 hip arthroplasties and 787,000 knee arthroplasties are performed yearly4. Many of these procedures are performed on Medicare recipients (approximately 400,000), and total joint arthroplasty represents the largest share of Medicare spending among inpatient surgical procedures5-7. The Centers for Medicare & Medicaid Services (CMS) has developed alternative payment models designed to decrease costs without negatively affecting outcomes. The Bundled Payment for Care Improvement program and the Comprehensive Care for Joint Replacement (CJR) program are recent attempts to control total joint arthroplasty cost8. It is unclear what effect these programs will have on outcomes, quality, or patient access.
The cost of implants is highly variable and represents a substantial financial portion of a total joint arthroplasty episode of care9. Therefore, among other factors, cost containment strategies must focus on lowering implant costs. Moreover, many higher-cost prostheses have unproven clinical benefits. This has led to novel discussions among surgeons and hospitals about whether patients should contribute to the costs of their implants. There are examples of patients paying for medical devices; however, there is no mechanism in place for patients to contribute toward arthroplasty implants10. Previous research suggests that U.S. patients are willing to pay for implants, and their motivations for doing so may be varied11-14.
Allowing patients to cost-share for implants generates myriad ethical dilemmas, and this article will review those dilemmas. This article will not discuss patient cost-sharing in other areas. Patient cost-sharing for implants has real potential to enhance patient autonomy, to increase transparency, to respect shared decision-making, and to strengthen the health-care system’s long-term financial viability. However, the …
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