Growing Orthopedic Needs Met with New Low-Cost Initiative

bcbsm

| 3 min read

A care worker checks on a patient's knee.
Orthopedic surgery is one of the most common procedures for musculoskeletal trauma. It’s a viable treatment that can repair bones, tendons, muscles, and ligaments. In recent years, the need for orthopedic medical care has grown exponentially causing an unexpected surge in rates. Planned orthopedic procedures cost approximately $25 billion in 2017, showing a 44 percent increase from 2010. The latest Blue Cross Blue Shield Association Health of America report, which utilizes the largest collection of commercial insurance data in the U.S. for Blue Cross members, found that the main cost driver is the rise of knee and hip procedures across all age groups. Historically, orthopedic care has centered older adults, but it’s becoming more common amongst Americans in their 40s and 50s. In 2017, more than 240,000 Blue Cross Blue Shield members under the age of 65 had a planned knee or hip replacement. Within a seven-year span, the number of patients between the ages of 45 and 54 increased by 17 (knee) and 25 (hip) percent. Meanwhile, the average price of replacements rose by 6 and 5 percent, respectively. To meet this growing need, BCBSM is providing orthopedic options that are high-quality and cost-efficient, such as our Blue Distinction® Centers. These facilities are nationally recognized for delivering safe, effective, and affordable treatment in a specific area of expertise. Members will find the best doctors and facilities, whether inpatient or outpatient—the latter of which is less expensive.
  • The average price for an inpatient knee replacement is $30,249, compared to $19,002 in an outpatient setting.
  • The average price for an inpatient hip replacement is $30,685, compared to $22,078 in an outpatient setting.
  • Overall, procedures performed at outpatient facilities cost 30-40 percent less than those in inpatient settings.
In 2018, BCBSM launched a bundled payment program to minimize orthopedic costs and improve aftercare. It offers medical providers a flat rate for all services rendered during a course of treatment. This eliminates hidden fees or other additional charges, allowing patients to solely focus on recovery. The plan targets a 10 percent savings for non-complicated knee or joint replacements. It is an all-inclusive goal that covers surgical procedures as well as the 90-day rehabilitation period. This is an integral part of an ongoing effort to make life-changing treatment even more accessible. The bundle is available to fully-insured members with Blue Cross PPO and the Blue Care Network HMO. It consists of 64 surgeons across seven Michigan healthcare systems. Providers participating in the orthopedic payment program include:
  • Henry Ford Health System
  • Huron Valley Sinai Hospital
  • Michigan Orthopaedic Surgeons
  • Oakland Regional Hospital
  • Joseph Mercy, Brighton
  • Joseph Mercy, Livingston
  • TRIARQ Health
Surgical procedures are covered in the following counties:
  • Genesee County
  • Ingham County
  • Jackson County
  • Livingston County
  • Macomb County
  • Oakland County
  • Saint Clair County
  • Washtenaw County
  • Wayne County
Photo credit: Sturti

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4 Comments

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Blues Perspectives

Feb 28, 2019 at 4:13pm

Thanks for your comment, Mike. If you have specific questions about a procedure you’re researching, please enter some information here: http://miblues.co/1Bb6oI4. Someone from our customer service team will reach out to you directly.

B
Blues Perspectives

Feb 25, 2019 at 6:57pm

Hi Lester, Thanks for sharing with us. If you're a Blue Cross Blue Shield of Michigan or Blue Care Network member and there's anything we can help with, we'd like to look into it for you. If you could provide us with some additional information here, http://miblues.co/1Bb6oI4, a member of our team will reach out to you directly. Thanks, Taylar

L
Lester Robertson

Feb 25, 2019 at 4:10pm

I understand the need to keep cost down but the rule that a MRI must be authorized for a shoulder injury puts the person in longer needless pain. A MRI is standard for shoulder rotor cuff tears and the DR. needs it to determine what to do. By having to be authorized it adds many days before treatment can start while the person is in PAIN. I know as I am that person. You spend lots of money sending out people to talk to me and give gift cards but I don't like hurting. I don't want needless tests but a MRI is standard for a rotorcuff injury. Let the DR,s do their job and help the person I know some test don't need to be done and are abused but some are standard and you can do a better job.

M
Mike Norman

Feb 23, 2019 at 3:32am

What about hand surgery?

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