Counterpoint: Joint implant prices are not the principal forces driving up the cost of joint replacement surgery

Abstract A recent Journal paper reported on trends in hip and knee implant pricing and hospital reimbursement.1 It used Medicare reimbursement and list prices “as proxies for hospital revenues and cost” for joint replacement procedures. The intent was to “… provide an indirect look at the profitability of TJA over the past decade.”1 We present evidence that the methods applied and conclusions reached are flawed. List price is not an accurate proxy for the average selling price (ASP) of implants. When ASPs for joint implants are analyzed, they are found to be declining. The contention of the study that the share of hospital revenue from these procedures going to purchase of the implants themselves is increasing is also inaccurate. Despite the reduction in implant ASP over the last several years, hospital charges and costs for primary joint replacements have continued to rise.