Geographic Variation in Physician Payments from Private Insurers for Commonly Performed Inpatient Orthopaedic Surgeries in the United States


We investigated geographic variation in percentage of private insurance payments to United States physicians for commonly performed orthopaedic procedures. We queried a private administrative claims database for patients who underwent inpatient total knee arthroplasty (TKA), total hip arthroplasty (THA), single-level anterior cervical discectomy and fusion (ACDF), and posterior lumbar fusion (PLF) from 2010 to 2017. Percentage of total payments to physician (PPP) was calculated by dividing physician payments by total payments. Analysis of variance was used to determine geographic differences in PPP. A total of 542,530 patients were included, mean age was 55 ± 8. PPP significantly varied between states for all four procedures (p < 0.001); Colorado and Alabama had the lowest and highest PPP, respectively. There was a significant annual decrease in PPP across all regions in all procedures. There was significant variation in percentage of total payments to physicians across geographic regions in the United States for TKA, THA, ACDF and PLF. (Journal of Surgical Orthopaedic Advances 30(1):014–019, 2021) Key words: geographic variation, percentage of total physician payments, private insurance, health economics research, cost effectiveness.

Majd Marrache, MD; Suraj Dhanjani, BS; Andrew B. Harris, BS; Varun Puvanesarajah, MD; Micheal Raad, MD; Olivia Petrusky, BS; Uma Srikumaran, MD; and Amit Jain, MD