Changes in the rate of publicly financed knee arthroscopies: an analysis of data from the Norwegian patient registry from 2012 to 2016

Abstract

ObjectiveTo examine rates of publicly financed knee arthroscopic surgery in Norway between 2012 and 2016.DesignAnalysis of anonymised data from the National Patient Registry.InterventionsBeginning in 2012, South-Eastern Norway Regional Health Authority implemented administrative measures to bring down rates of knee arthroscopy. Similar measures were not introduced in the other three Regional Health Authorities.Main outcome measuresWe analysed annual national rates of publicly financed knee arthroscopies in 2012 and 2016. We compared the rates in South-Eastern Norway Regional Health Authority with corresponding rates in the rest of the country. Variations by county, public hospital versus publicly reimbursed private hospital, gender and age were also assessed.ResultsThe overall annual rate of arthroscopic procedures declined by 33% from 2012 to 2016, from 310 to 207 per 100 000 inhabitants, respectively. Hospitals in South-Eastern Norway Regional Health Authority reported a 48% reduction, compared with mean 13% in the other three Regional Health Authorities. In public hospitals, rates decreased nationally by 42%, while rates in publicly reimbursed private hospitals increased by 12%. Rates in publicly reimbursed private hospitals decreased by 30% in South-Eastern Norway Regional Health Authority but increased by 63% in the other Regional Health Authorities. The proportion of patients ≥50 years (excluding meniscal repairs) in Norway was 54% in 2012 and fell to 46% in 2016. Average rates per county varied by a factor of 3:1.ConclusionWe report a marked overall reduction of knee arthroscopic procedures from 2012 to 2016 in publicly funded hospitals. The largest decrease was reported in South-Eastern Norway Regional Health Authority, and this coincides in time with implemented administrative measures. The results suggest that the trend of increasing rates of knee arthroscopies can be reversed through purposeful professional and administrative interventions.

Trends in knee magnetic resonance imaging, arthroscopies and joint replacements in older Australians: still too much low‐value care?

“…We found only a modest 15% decrease in arthroscopies between 2003 and 2017. This was smaller than decreases observed in Florida, where a 23% relative decrease in knee arthroscopy between 2002 and 2015 was found, and Norway, where a 33% decrease between 2012 and 2016 was reported . While arthroscopies decreased from 2008 in Florida, a sustained decline in knee arthroscopy use in Australia was only observed after 2014, more than a decade after the first published placebo‐controlled trial showed arthroscopy was showed arthroscopy for osteoarthritis was of no benefit over placebo …”

Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions

“…However, the most recent data do not show a similar decrease in the number of APMs performed 2 12. To further reduce the number of APMs, more effort is needed such as the implementation of administrative measures or (local) policy changes, which were earlier proven to be effective in reducing the number of knee arthroscopies in Norway and Australia 35 36…”

Associations between utilization rates and patients’ health: a study of spine surgery and patient-reported outcomes (EQ-5D and ODI)

“…Variation in preferences are cultural phenomenons, as physicians are quick to adapt their behavior to the enviroment they operate in [26]. Possible approaches to reduce such variation include peer review of practice patterns, such as clinical audits, educational initiatives, development of standardized decision support and leverage of economical incentives, such as the reimbursment per procedure [27]. On the other hand, differences in capacity, such as the number of spine surgeons per population, or surgeons availablity to operating rooms, may cause variation.…”