Kiplingers Personal Finance

68 KIPLINGER’S PERSONAL FINANCE^ 05/2017

HEALTHY LIVING

must be healthy and personally moti-

vated. If your surgeon offers outpa-

tient surgery as an option and you’re

covered by employer group insurance,

check with your insurer to see how

coverage for inpatient surgery and out-

patient surgery differ. Medicare will

require you to have your joint replace-

ment performed as an inpatient proce-

dure, under Part A of your coverage.

ROAD TO RECOVERY

With your new hip or knee, you’ll be

ready to leave the hospital when you

can walk safely with a walker or

crutches, you can ascend and descend

a few stairs, and your pain is under

good control with oral medication.

Most patients will do best if they go

CONSIDER YOUR COST

If your network doesn’t include a doc-

tor who is right for your case—say, you

have had previous surgery on the joint,

you have multiple medical problems,

or you have complex bone deformities

that will make the procedure more

difficult—it may be worthwhile to go

out of network. If that’s the case, or if

your insurance requires you to pay a

large share of the cost, you owe it to

yourself to shop for the best price as

well as the best surgeon.

The cost of total joint replacement

varies in the U.S.—and even within

many cities—with prices ranging

roughly from $20,000 to $60,000,

says Bill Kampine, senior vice presi-

dent and cofounder of the Healthcare

Bluebook. The company collects claims

and payment data from health plans

and calculates a fair price for proce-

dures. (To see the price in your city,

visit http://www.healthcarebluebook.com

and click on “consumers.”) Kampine

says fees vary little among doctors but

greatly among facilities. That can

make a big difference in your out-of-

pocket cost after any deductible.

One way to shop? The Blue Cross

Blue Shield Association has created

the Blue Distinction Centers+ designa-

tion (www.bcbs.com/blue-distinction-

center-finder; search by location) for

hospitals that deliver expert specialty

care, including hip and knee replace-

ment, and that are at least 20% more

cost-effective than non-designated fa-

cilities. Call designated hospitals and

ask what they charge. If it’s close to

the fair price, choose a highly rated

surgeon who admits there. (For more

on finding hospitals that specialize in

certain procedures at a competitive

price, see “Travel Abroad for Low-

Cost Care,” Jan.)

Some joint replacements now are

performed on an outpatient basis at an

ambulatory surgery center. After sur-

gery, you return home the same day or

after a single overnight stay. This ar-

rangement may be less expensive and

more convenient than in-patient sur-

gery, but it’s not for everyone. You

for a referral, and visit your insurer’s

website to search for specialists and

hospitals in your network. Look for

surgeons who belong to the American

Association of Orthopaedic Surgeons

(go to http://www.aaos.org and click on

“find an orthopaedist”) and the

American Association of Hip and

Knee Surgeons (go to http://www.aahks

.org and click on “find a doctor”).

You can read patient reviews of physi-

cians and find out where they have

admitting privileges at http://www.health

grades.com.

You’ll be best served by an orthope-

dic surgeon who took an extra year of

postgraduate fellowship training and

specializes in joint replacement (see

“To Your Health,” April). The more

joint-replacement experience that a

surgeon and hospital have, the less the

likelihood of complications. A rule of

thumb: The surgeon should perform

more than 50 hip replacements or 50

knee replacements annually at a hospi-

tal where more than 250 total joint

replacements are performed a year.

Most high-volume hospitals offer

joint-replacement programs with

preoperative education for patients,

a dedicated nursing unit and protocols

designed to help you go home more

quickly.

The federal Centers for Medicare

and Medicaid Services rates hospitals

based on several performance criteria,

including rates of complications and

readmission following hip and knee

replacements (www.medicare.gov/

hospitalcompare). You can also search

for physicians by name, location, spe-

cialty or body part (www.medicare

.gov/physiciancompare), but top sur-

geons who may be a good fit for you

won’t be listed if they don’t accept

Medicare patients.

Your insurer will require you to be

preauthorized for total joint replace-

ment. Medicare requires your physi-

cian to document medical necessity

with your medical history, the results

of a physical examination and x-rays,

as well as the surgeon’s clinical judg-

ment that surgery is appropriate.

■ Bad knees sidelined

Christopher Jorgensen

until he had both replaced.