Declining Medicaid Reimbursement for Total Hip and Knee Arthroplasty from 2014 to 2022: A Comparison of Expansion and Non-Expansion States.

Abstract

The purpose of this study was to evaluate national- and state-level trends in inflation-adjusted Medicaid physician reimbursement for total knee arthroplasty (TKA) and total hip arthroplasty (THA) from 2014 to 2022 and to assess whether these trends differ based on Medicaid expansion status. Average physician reimbursement per patient for TKA and THA from 2014 to 2022 was extracted from a large insurance claims database. All monetary values were adjusted for inflation using the Consumer Price Index and reported in 2022 United States dollars. For each procedure, the total percentage change in reimbursement over the study period as well as the average annual percentage change was calculated. Data were then broken down by state, and states were categorized based on Medicaid expansion status (expanded versus non-expanded). Between 2014 and 2022, the national weighted average reimbursement for TKA declined from $2,024 to $1,579, representing an overall decrease of 22.0%. The annual percentage change for TKA reimbursement was -3.0% per year (P = 0.003). For THA, reimbursement decreased from $2,050 to $1,395, an overall reduction of 31.9%, with an annual percentage change of -4.7% per year (P = 0.048). When stratified by Medicaid expansion status, TKA reimbursement declined at similar rates in expansion states (-2.4%) and non-expansion states (-2.7%) (P > 0.05). Similarly, THA reimbursement declined with a percentage change of -3.2% in expansion states and -5.4% in non-expansion states (P > 0.05). Medicaid reimbursement for TKA and THA procedures declined significantly from 2014 to 2022, with similar drops in both Medicaid expansion and non-expansion states.