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Hip surgery: a procedure surges in popularity

Gigi Douban Apr 28, 2015
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More than 320,000 people a year undergo hip replacement surgery in the U.S., according to the latest data from the American Association of Orthopedic Surgeons. The total number has increased dramatically since 2000, the Centers for Disease Control says.

People are having the surgery done younger and younger. The costs can be unpredictable, but doctors and insurers are trying to keep a lid on this expensive procedure.  

On a recent Thursday, Darlene Oglesby comes in for her post-operative follow-up using a walker, but not really using it. The physician’s assistant at Andrews Sports Medicine and Orthopedic Center in Birmingham does a quick check on her.

Two weeks before, Oglesby had a total hip replacement. And to realize how big a deal it is that she’s walking so easily, you have to know how things were before the surgery: sitting for a long time hurt. Getting out of bed hurt. Walking hurt. 

“And then it progressively got worse to where I could not walk up stairs without being in tears,” Oglesby says.  “And we tried therapy, we tried injections. Didn’t work.”

Oglesby’s doctor told her she had arthritis. And that she needed a hip replacement. She was ready.

Oglesby is 50, which might seem young to have a hip replaced. But it’s not anymore. Since the year 2000, according to the CDC, hip replacements among people aged 45 to 54 more than tripled. That’s the biggest percentage change of any age group. 

Randeep Kahlon, an orthopedic surgeon and an Arthritis Foundation board member, says a lot of people over 65 expect to have aches and pains. 

“But in your 40s and 50s, you’re still considered a contributor to the workforce, and that kind of pain is something people are not ready to live with or don’t want to live with,” he says. 

Plus, people this age are more active than they used to be. They run marathons, they do yoga. So, Kahlon says, a lot of them say, “Why wait?” But also, younger, healthier patients who have replacements stay in the hospital fewer days, and they recover faster than older patients. That’s a big perk  for hospitals and insurance companies trying to keep costs down. 

Another way to cap costs? Bundled payments, where insurers pay the hospital or the medical group a flat fee. 

Nationally, procedure costs ranged from a low of about $11,000 to more than $125,000, according to a 2013 study. A flat fee includes everything, from the implant device to post-op care. It’s all negotiated up front, so there are no surprises. Wal-Mart and Lowe’s brokered deals like this with four hospitals across the U.S. Employees of those companies who choose one of these centers don’t pay anything out of pocket, even travel costs.

A spokesman for Lowe’s told Marketplace it ensures better outcomes, and their employees get back to work faster. That saves the company money. 

Kahlon says joint replacements are the most aggressively marketed orthopedic procedures for bundled payments. 

Lisa Warren, CEO at Andrews Sports Medicine and Orthopedic Center, where Darlene Oglesby had her hip replaced, says her practice is looking into sending patients overseas. Warren says it’s a lot cheaper. In Costa Rica, she says, the surgery costs less than half what it would in the U.S. “They can do the total hip with the physician component, with two-week stay, with the rehab for about $18,000,” Warren says. 

That includes travel. And recuperating in a very nice place, Warren says. She says it might makes sense to people who maybe couldn’t afford a hip replacement here. 

Still, co-pays and deductibles are going up. And Warren wonders whether that will cut into the volume of hip replacements at her busy practice. Could be, she says, more people will decide, “Hey, maybe it can wait.”

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