Bundled Payments Are Effective in Reducing Costs Following Bilateral Total Joint Arthroplasty

Rondon, Alexander J.; Phillips, Jessica; Fillingham, Yale A.; Gorica, Zylyftar; Austin, Matthew S.; Courtney, P. Maxwell

doi:10.1016/j.arth.2019.03.041

Cited by 30 publications

(16 citation statements)

References 32 publications

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“…This study suggests that there is significant variance in cost, readmission, and length of stay in the hip and femur fractures bundle. The one-size-fits-all model of reimbursement is potentially powerful, 27 but may be too rigid for this bundle that encompasses such a heterogenous group of procedures. Further stratification and specific billing bundles that ensure appropriate reimbursement for providers and facilities could help mitigate these concerns and increase bundle participation, reducing overall costs to all parties involved.…”

Section: Discussionmentioning

confidence: 99%

Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures

Rose

Cherney

Jensen

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction The Bundled Payment for Care Improvement (BPCI) for hip and femur fractures is an effort to increase care quality and coordination at a lower cost. The bundle includes all patients undergoing an operative fixation of a hip or femur fracture (diagnosis-related group codes 480-482). This study aims to investigate variance in the hospital cost and readmission rates for patients within the bundle. Materials and Methods The study is a retrospective analysis of patients ≥65 years old billed for a diagnosis-related groups 480-482 in 2016 in the National Readmission Database. Cost of admission and length of stay were compared between patients who were or were not readmitted. Regression analysis was used to determine the effects of the primary procedure code and anatomical location of the femur fracture on costs, length of stay, and readmission rates. Results Patients that were readmitted within 90 days of surgery had an increased cost on initial admission ($18,427 vs $16,844, P < .0001), and an increased length of stay (6.24 vs 5.42, P < .0001). When stratified by procedure, patients varied in readmission rates (20.7% vs 19.6% vs 21.8%), initial cost, and length of stay (LOS). Stratification by anatomical location also led to variation in readmission rates (20.7% vs 18.3% vs 20.6%), initial cost, and LOS. Conclusion The hip and femur fractures bundle includes a great number of procedures with variance in cost, readmission, and length of stay. This amount of variation may make standardization difficult and may put the hospital at potential financial risk.

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Section: Discussionmentioning

confidence: 99%

Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures

Rose

Cherney

Jensen

et al. 2021

Geriatr Orthop Surg Rehabil

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“…With the recent transition toward value-based care, the overall cost has become an increasingly important consideration when deciding between different treatment strategies. Arthroplasty accounts for a substantial proportion of health care spending in the United States [11]. Proponents of simultaneous bilateral THA and TKA cite cost savings as a benefit over a staged procedure, as patients only undergo anesthesia once and require a single hospital stay [12,13].…”

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confidence: 99%

A Time-Driven Activity-Based Costing Analysis of Simultaneous Versus Staged Bilateral Total Hip Arthroplasty and Total Knee Arthroplasty

Goh¹,

Sutton²,

D’Amore³

et al. 2022

The Journal of Arthroplasty

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“…2,3 A number of studies have demonstrated that a notable portion of payments in the 90-day episode-of-care is related to postdischarge costs. 4,5 Therefore, optimization of postdischarge care has become a critical aspect of the quality initiative and a major area for cost containment in bundled care models. 6 At our institution, symptoms related to concern for deep vein thrombosis (DVT) are the most common reason for emergency department (ED) referral after total joint arthroplasty (TJA), and similar findings have been reported in the literature.…”

mentioning

confidence: 99%

Emergency Department Visits After Total Joint Arthroplasty for Concern for Deep Vein Thromboses

Grosso

Chisari

Vannello

et al. 2021

J Am Acad Orthop Surg

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Background: Concern for deep vein thrombosis (DVT) is the most common reason for emergency department (ED) referral after total joint arthroplasty (TJA) at our institution. We aim to investigate the referral pathway, together with the cost and outcomes associated with patients who access an ED because of concern for DVT after TJA. Methods: We reviewed a consecutive series of all primary hip and knee arthroplasty patients who accessed the ED for concern for DVT within 90 days of surgery over a one-year period. The referral source and costs associated with the ED visit were collected. A propensitymatched control cohort (n = 252) that was not referred to the ED for DVT was used to compare patient-reported outcomes measures. Results: In 2018, 108/10,445 primary TJA patients (1.0%) accessed the ED for concern about DVT. The most common reason for accessing the ED was self-referral (69, 64%), followed by orthopaedic on-call referral (21, 19%). Only 15 patients (14%) were found to have ultrasonography evidence of DVT. The mean cost for accessing the ED for DVT for patients with public insurance was $834 (range $394-$2,877). When compared with the control cohort, patients who accessed the ED for DVT had significantly lower postoperative functionality scores (52.5 versus 65.9, P , 0.001). Discussion: At our institution, 1% of patients who undergo primary TJA accessed the ED for concern for DVT at substantial cost, with only a small portion testing positive for DVT. Self-referral is by far the most common pathway. Additional investigations will be aimed at determining better pathways for DVT work-up, while ensuring appropriate management.

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Bundled Payments Are Effective in Reducing Costs Following Bilateral Total Joint Arthroplasty

Cited by 30 publications

References 32 publications

Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures

Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures

A Time-Driven Activity-Based Costing Analysis of Simultaneous Versus Staged Bilateral Total Hip Arthroplasty and Total Knee Arthroplasty

Emergency Department Visits After Total Joint Arthroplasty for Concern for Deep Vein Thromboses

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