ArticleJSES reviews, reports, and techniques2026
Hospital, regional, and policy-level variations in shoulder arthroplasty prices: a Nationwide database study.
Article in JSES reviews, reports, and techniques, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Surgical reconstruction via hemiarthroplasty, anatomic total shoulder arthroplasty (aTSA), or reverse total shoulder arthroplasty (rTSA) is a common approach for treatment of various shoulder pathologies. Little is known about variations in negotiated payor rates for these procedures. The objective of this study was to examine hospital, regional, and policy-level factors associated with variations in negotiated rates for total shoulder arthroplasty (TSA) and hemiarthroplasty across the United States. Methods: A cross-sectional analysis was performed with 2024 payor rate data from the Turquoise Health Database, using current procedural terminology codes for hemiarthroplasty (23470) and rTSA/aTSA (23472). Variables of interest were downloaded from publicly available sources, including hospital size, payor class, metropolitan/nonmetropolitan classification, regional household income, and Area Deprivation Index. State-level policies included Medicaid expansion status, certificate-of-need (CON) status, nurse practitioner scope-of-practice regulations, and participation in the All-Payer Claims Database (APCD). Multivariable linear regressions were used to assess associations between payor rates and variables of interest. Results: In total, 516,904 total rates were evaluated (256,422 hemiarthroplasty; 260,480 rTSA/aTSA). The unadjusted mean negotiated rate was $9,082 (standard deviation: $1,182) for hemiarthroplasty and $10,840 (standard deviation: $1,405) for TSA. In a separate multivariable analysis, the mean rate difference was $68 (95% CI: $35-$102). Hospital bed capacity was tied to variations in both cohorts. Metropolitan hospitals reported higher payor rates for both hemiarthroplasty (+$2,151.46) and rTSA/aTSA (+$879.73) in comparison to nonmetropolitan hospitals. Medicaid expansion was associated with higher rates for both cohorts, while increased nurse practitioner scope of practice, CON status, and APCD database participation were associated with lower rates ( Conclusion: Shoulder arthroplasty negotiated payor rates show large variations and are associated with several factors, including hospital size, payor class, and regional factors. Mean TSA rates were $68 higher, a clinically insignificant amount. States with CON laws and APCD database participation have lower payor rates while states with Medicaid expansion have higher rates. These findings underscore significant variations in how hospitals and payors negotiate rates for shoulder arthroplasty, emphasizing the many factors that play a role in shaping surgical costs.
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