Payments for hip and knee replacements vary greatly in Colorado: 4 findings

Some Colorado residents pay significantly more than Medicare beneficiaries for the same service, according to a new report from the Center for Improving Value in Health Care.

The report reveals significant variation in payments for hip and knee replacements between private health insurance payers and Medicare.

Here are four findings from the report.

1. Commercial insurance payments for hip and knee replacement are as much as 232 percent higher, or $55,000 more than Medicare, the report found.

2. Privately insured residents in the northeast part of Colorado pay $55,000 more than their neighbors with Medicare while those in Denver pay $17,000 more than Medicare prices.

3. The report also found the Western Slope of Colorado, which encompasses Grand Junction, has the third highest commercial costs in the state after the northeast and mountain regions. Coloradans with commercial insurance along the Western Slope pay around $26,000 more than Medicare recipients receiving a knee or hip replacement.

4. In the mountain region, the disparity between commercial insurance and what Medicare pays is over $43,000 more.

The report's authors did not identify a key reason for such price disparity. However, Ana English, president and CEO of CIVHC, said in a prepared statement the disparity "gives us an opportunity to ask why this is happening, whether it's warranted and where we have opportunities to reduce costs and improve care."

"This type of analysis from the Colorado All Payer Claims Database suggests that we have the potential to do a much better job controlling costs in some areas," she added.

In light of the report's findings, many state groups, including the Colorado Commission on Affordable Health Care, are exploring ways to identify where Colorado can make improvements — either with data in the CO APCD or from other sources, according to a news release.



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