Planned Orthopedic Surgery Spending Increased 44 Percent to $25 Billion Since 2010 as Generation X Americans Opt for Knee and Hip Replacements at Earlier Age

CHICAGO – Planned knee and hip replacement procedures continue to climb in cost and volume, particularly among younger Americans, according to a review of medical claims data from 2010-2017 by the Blue Cross Blue Shield Association (BCBSA). Knee replacements are up by 17 percent and hip replacements are up 33 percent. Costing more than $25 billion in 2017, planned orthopedic surgeries account for 47 percent of total orthopedic spending, reflecting a 44 percent increase since 2010. During the same time period, the average price of knee and hip procedures increased by 6 percent and 5 percent respectively.  

The increase in the number of knee and hip procedures during this seven-year period is the main cost driver, as the number of knee and hip procedures has sharply risen across nearly all ages under 65.

“As a leader in health care, providing coverage for one in three Americans, we know access to quality health care is important to our members, particularly as Gen X Americans—those younger than 55—are also undergoing hip and knee replacement procedures at increasing rates across the country,” said Mark Talluto, vice president, strategy and analytics, BCBSA. “Blue Cross and Blue Shield (BCBS) companies have made it a priority to provide members more tools and options to make informed decisions about the best care to meet their needs.”

The report, “Planned Knee and Hip Replacement Surgeries Are on the Rise in the U.S.,” represents a study of trends in cost and quality of care for elective orthopedic surgical procedures, specifically knee and hip replacements. Some of the additional findings include: 

•    The average price for an inpatient knee replacement is $30,249, as compared to $19,002 in an outpatient setting. The average cost of an inpatient hip replacement is $30,685 compared to $22,078 in an outpatient setting. 

•    Knee and hip procedures performed in an outpatient setting are significantly lower in price than in an inpatient setting at a savings of between 30 to 40 percent.

•    Over a four-year period from 2013-2017, outpatient complication rates substantially improved by 23 percent for knee procedures and 36 percent for hip procedures (comparable to an inpatient setting).

•    Despite these potential outpatient setting savings, only 11 percent of knee procedures and 8 percent of hip procedures were performed on an outpatient basis in 2017. 

The location and setting of an individual’s procedure, such as outpatient versus inpatient, has a direct impact on its total cost. To help consumers identify higher quality, affordable inpatient and outpatient centers, BCBS companies created the Blue Distinction® Centers+ designation, which recognizes health care facilities that demonstrate expertise in delivering patient care safely and effectively, while also being 24 percent or more cost-efficient than non-designated facilities. Quality comes first: only those hospitals that first meet national established quality measures for Blue Distinction Centers are considered for designation as a Blue Distinction Center+. 

It is also critical that consumers have access to meaningful, credible information regarding medical practitioners. BCBS companies offer an array of transparency tools that provide standardized health care cost and quality information (including cost estimates, practitioner quality information and access to patient reviews), enabling consumers to comparison shop for hundreds of common treatments and procedures. Members have access to consumer transparency tools on their BCBS company’s member portal or at the National Doctor and Hospital Finder.

This is the 23rd study of the Blue Cross Blue Shield, The Health of America Report® series, a collaboration between BCBSA and Blue Health Intelligence (BHI), which uses a market-leading claims database to uncover key trends and insights in health care affordability and access to care. The report was done in partnership with HealthCore, a wholly owned and independently operated health outcomes subsidiary of Anthem, Inc. This report identifies trends in cost and quality of care for elective or planned orthopedic surgical procedures (specifically knee and hip replacements) by examining the medical claims of more than 48 million Blue Cross and Blue Shield commercially insured members from 2010 through 2017.

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The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.