New research from the Health Care Cost Institute (HCCI) shows that healthcare costs for three common procedures, including knee injections, ACL repairs, and knee replacements, varied greatly across 61 metro areas.
The results were measured against national benchmarks for prices, services used, practice patterns and spending.
The report defines spending as the actual amount paid by payers to providers for the treatment. Price is defined as the average amount of reimbursement allowed for each procedure.
The report collected data from three healthcare provider settings; inpatient (knee replacement), outpatient (ACL repair), and physician (knee injection).
The spending for ACL repair had the largest range in spending with a 0.36 difference between the 75th and 25th percentiles. Knee injection and knee replacement came in with spending differences of 0.23 and 0.21, respectively.
The widest range in prices was seen for knee injections. The difference between the maximum and minimum knee injection prices indices was 1.23.
Knee injection prices had the widest variation, but the treatment itself had the lowest average price.
Average spending for an ACL repair was over 30 times greater than spending for a knee injection, and clocked in at 98 times the spending of a knee replacement.
When prices were compared the differences seen were even larger. Prices ranged 51 times greater for ACL repair, and 163 times greater for knee replacement, when compared to knee injection average pricing.
Some regions reported lower than average spending and prices, while additional results showed a wide range of prices and spending within a single metro market.
For ACL repair the lowest spending was found in Knoxville, Tennessee, at 0.55 below the median index value, it was joined by several other Tennessee metros. However, the lowest prices were in Colorado Springs, Colorado, Tucson, Arizona and Augusta-Richmond County, Georgia-South Carolina.
In keeping with the knee injection spending, the highest ACL repair spending was spread across several metros in Wisconsin.
Knee replacement spending and pricing had the tightest correlation to each other statistically of the three services measured. The highest spending, and therefore prices, were seen in Texas throughout several metros.
By examining the price and spending indices, a clear outcome emerged indicating that above and below average spending was directly related to prices in those metros.
Although prices and spending can vary in different geographic markets, and even within one market, the study concluded that the findings stress the need for specific research questions and subsequently targeted policy proposals within each individual metro marketplace…
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