Can Bundled Payments Be Successful in the Medicaid Population for Primary Joint Arthroplasty?

Courtney, P. Maxwell; Edmiston, Tori A.; Batko, B; Levine, Brett R.

doi:10.1016/j.arth.2017.05.035

Cited by 31 publications

(13 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Specifically, Medicaid payer status is associated with increased 90-day and overall readmission rates, length of stay, and direct cost. These findings are consistent with previous orthopaedic literature [22], [23], [24], [25] and is the largest patient sample size evaluating Medicaid patients and TKA from a national standpoint. There are a few small retrospective cohort studies evaluating Medicaid status with increased 90-day readmission and 1 large national inpatient sample study looking at Medicaid inpatient reporting only [1], [25].…”

Section: Discussionsupporting

confidence: 92%

“…These findings are consistent with previous orthopaedic literature [22], [23], [24], [25] and is the largest patient sample size evaluating Medicaid patients and TKA from a national standpoint. There are a few small retrospective cohort studies evaluating Medicaid status with increased 90-day readmission and 1 large national inpatient sample study looking at Medicaid inpatient reporting only [1], [25]. This study is the first to assess a large national database on the impact of Medicaid payer status on resource utilization via 90-day and overall readmission rates, length of stay, and direct cost in TKA patients.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Medicaid is associated with increased readmission and resource utilization after primary total knee arthroplasty: a propensity score–matched analysis

et al. 2018

View full text Add to dashboard Cite

BackgroundMedicaid payer status has been shown to affect resource utilization across multiple medical specialties. There is no large database assessment of Medicaid and resource utilization in primary total knee arthroplasty (TKA), which this study sets out to achieve.MethodsThe Nationwide Readmissions Database was used to identify patients who underwent TKA in 2013 and corresponding “Medicaid” or “non-Medicaid” payer statuses. Demographics, 15 individual comorbidities, readmission rates, length of stay, and direct cost were evaluated. A propensity score–based matching model was then used to control for baseline confounding variables between payer groups. A chi-square test for paired proportions was used to compare readmission rates between the 2 groups. Length of stay and direct cost comparisons were evaluated using the Wilcoxon signed-rank test.ResultsA total of 8372 Medicaid and 268,261 non-Medicaid TKA patients were identified from the 2013 Nationwide Readmissions Database. A propensity score was estimated for each patient based on the baseline demographics, and 8372 non-Medicaid patients were propensity score matched to the 8372 Medicaid patients. Medicaid payer status yielded a statistically significant increase in overall readmission rates of 18.4% vs 14.0% (P < .0001, relative risk = 1.31, 95% confidence interval [1.23-1.41]) with non-Medicaid status and 90-day readmission rates of 10.0% vs 7.4%, respectively (P < .001, relative risk = 1.35, 95% confidence interval [1.22-1.48]). The mean length of stay was longer in the Medicaid group compared with the non-Medicaid group at 4.0 days vs 3.3 days (P < .0001) as well as the mean total cost of $64,487 vs $61,021 (P < .0001).ConclusionsThis study demonstrates that Medicaid payer status is independently associated with increased resource utilization, including readmission rates, length of stay, and total cost after TKA.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Medicaid is associated with increased readmission and resource utilization after primary total knee arthroplasty: a propensity score–matched analysis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Some institutions have also elected to participate in a voluntary bundled payment model with the CMS for revision TKA to maximize reimbursement [9]. However, concerns exist about access to care in these value-based programs for patients with higher cost arthroplasty who may use more resources in an episode of care [11,18]. In current reimbursement models, payers do not differentiate between patients undergoing revision TKA for infection and those undergoing We hope our study can impact policymakers in adjusting reimbursement for facilities and surgeons that care for patients with an infected TKA.…”

Section: Discussionmentioning

confidence: 99%

Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA

Courtney

Boniello

Valle

et al. 2018

Clin Orthop Relat Res

Self Cite

View full text Add to dashboard Cite

Background The Medicare Access and CHIP Reauthorization Act of 2015 provides the framework to link reimbursement for providers based on outcome metrics. Concerns exist that the lack of risk adjustment for patients undergoing revision TKA for an infection may cause problems with access to care. Questions/purposes (1) After controlling for confounding variables, do patients undergoing revision TKA for infection have higher 30-day readmission, reoperation, and mortality rates than those undergoing revision TKA for aseptic causes? (2) Compared with patients undergoing revision TKA who are believed not to have infections, are patients undergoing revision for infected TKAs at increased risk for complications? Methods We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients undergoing revision TKA from 2012 to 2015 identified by Current Procedural Terminology (CPT) codes 27486, 27487, and 27488. Of the 10,848 patients identified, four were excluded with a diagnosis of malignancy (International Classification of Diseases, 9th Revision code 170.7, 170.9, 171.8, or 198.5). This validated, national database records short-term outcome data for inpatient procedures and does not rely on administrative coding data. Demographic variables, comorbidities, and outcomes were Each author certifies that neither he, nor any member of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

show abstract

“…The payment landscape in hip and knee arthroplasty has shifted from a fee for service model to a value-based reimbursement model. Multiple fixed payment models have subsequently been introduced by the Centers for Medicare and Medicaid Services, which have demonstrated satisfactory outcomes in certain arthroplasty settings 7, 13, 24, 26. An example of this is the Bundled Payments for Care Improvement (BPCI) model.…”

mentioning

confidence: 99%

Ninety-day readmissions following reverse total shoulder arthroplasty

et al. 2019

View full text Add to dashboard Cite

Background An adequate characterization of 90-day readmissions after primary reverse total shoulder arthroplasty (RTSA) on a national level remains to be undertaken. As bundled payment models become more prevalent, an improved understanding of readmission data will help to predict resource utilization and expenses. Methods All adult patients who underwent elective primary RTSA in 2014 in the National Readmission Database were included in the analysis. Two cohorts were created based on 90-day readmission status. Multivariate analysis was then performed to determine predictors of 90-day readmissions. Reasons for 30-, 60-, and 90-day readmissions were identified. Total hospital resource utilization was calculated. Results An estimated 25,196 patients were identified. The 30-, 60-, and 90-day rates of readmissions were 0.6%, 1.2%, and 1.7%, respectively. Diabetes (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.14-1.78), hypertension (OR, 1.63; 95% CI, 1.28-2.08), paralysis (OR, 3.61; 95% CI, 1.63-7.97), and solid tumor without metastasis (OR, 2.72; 95% CI, 1.21-6.12) were identified as independent predictors of 90-day readmission. Ninety-day readmissions were associated with a significant increase in cost ( P = .02). The most common related reason for 90-day readmission was hardware-related complications at all time points. Conclusion Although uncommon, 90-day readmissions after primary RTSA are associated with significant patient morbidity and consequently substantial hospital costs.

show abstract

Can Bundled Payments Be Successful in the Medicaid Population for Primary Joint Arthroplasty?

Cited by 31 publications

References 15 publications

Medicaid is associated with increased readmission and resource utilization after primary total knee arthroplasty: a propensity score–matched analysis

Medicaid is associated with increased readmission and resource utilization after primary total knee arthroplasty: a propensity score–matched analysis

Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA

Ninety-day readmissions following reverse total shoulder arthroplasty

Contact Info

Product

Resources

About