Elective Joint Replacements Could Save the Nation Billions Every Year

Elective hip and knee replacements may represent a significant source of potentially controllable healthcare spending, according to a March 13 Viewpoint article published in the Journal of the American Medical Association (JAMA) and authored by members of the Center for Health Advancement at the UCLA Fielding School of Public Health (FSPH).
 
According to the Agency for Healthcare Research and Quality, in 2014, approximately 505,000 hip replacements and 723,000 knee replacements were performed in the U.S., representing a cost of more than $20 billion. And hip and knee replacements in the U.S. have increased substantially, according to the most recent data report from the Organisation for Economic Co-operation and Development.
 
“With the U.S. currently spending nearly 18 percent of its gross domestic product on medical care, almost twice as much as other high-income countries, we need to look at every opportunity to reduce costs from services that may be over-utilized. Elective joint replacements could represent an area for significant savings,” said co-author Jonathan Fielding, M.D., MPH, MA, MBA, Distinguished Professor at the Fielding School of Public Health and the David Geffen School of Medicine at UCLA, and founder and co-director of the Center for Health Advancement.
 
The article includes several recommendations for reducing costs associated with hip and knee replacements, including:
 

• Creating decisions aids to educate patients about alternatives and risks to help them possibly delay or avoid unnecessary procedures.
• Capping payments for hip and knee replacements in order to reduce variation.
• Providing hospitals and other purchasers with price information to help them to make cost-effective decisions.
• Encouraging orthopedic surgeons to perform hip and knee procedures in outpatient settings when appropriate.

 
“Avoiding inappropriate procedures and controlling device and surgical costs could possibly save the U.S. medical care system many billions annually,” said co-author Steven Teutsch, M.D., MPH, adjunct professor at UCLA FSPH and collaborator with the Center for Health Advancement.
 
Vanessa Lam, BA, a graduate student in the Fielding School’s Department of Health Policy and Management and the UCLA Luskin School of Public Affairs, also co-authored the report.