Correlation Between Physician Specific Discharge Costs, LOS, and 30-day Readmission Rates: An Analysis of 1,831 cases

Ramos, Nicholas; Wang, Emily L.; Karia, Raj; Hutzler, Lorraine; Lajam, Claudette M.; Bosco, Joseph

doi:10.1016/j.arth.2014.04.005

Cited by 50 publications

(26 citation statements)

References 20 publications

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“…Ramos et al examined Medicare claims data and determined the average costs were $16,464 when discharging to an IRF, $6,678 to a SNF, $4,239 to HHC, and $733 for routine discharge home with outpatient therapy [11]. Using the example of an institution performing 100 THAs annually, there would be the potential to reduce costs by up 69.9 % or $280,647 if they were discharged according to the percentages found in the present study as opposed to those reported in the AHRQ HCUPnet database ( Table 3).…”

Section: Discharge Statusmentioning

confidence: 99%

Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique

Gofton

Chow

Olsen

et al. 2014

International Orthopaedics (SICOT)

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Purpose Recent studies have reported nearly 40 % of costs associated with a 30-day episode-of-care for total joint replacements are due to post-discharge activities and 81 % of those are specifically due to unplanned readmissions and discharging patients to post-acute care facilities. The purpose of this study was to determine these two key variables for total hip arthroplasty (THA) patients implanted using a tissuesparing surgical technique and to see how these values compare to those previously reported in the United States. Methods The healthcare databases at three institutions were searched for primary THA patients implanted using the supercapsular percutaneously-assisted total hip (SuperPath) surgical technique between January 2013 and July 2014. Data elements included 30-day all-cause readmission rate, discharge status, transfusion rate, complications, and length of stay (LOS). Results Data were available for 479 THAs. The 30-day allcause readmission rate, transfusion rate, and average LOS was 2.3, 3.3 %, and 1.6 days, respectively. Over 91 % of patients were discharged routinely home, 4.1 % to skilled nursing facilities, 3.8 % to home health care, and 0.6 % to inpatient rehabilitation facilities. Complications included dislocation (0.8 %), periprosthetic fracture (0.8 %), and deep vein thrombosis (0.2 %). There were no infections reported. Conclusions Patients implanted using this tissue-sparing technique experienced reduced 30-day all-cause readmission rates (2.3 % vs. 4.2 %) and more were routinely discharged home (91.5 % vs. 27.3 %) than have been previously reported for patients in the United States. Use of this tissue-sparing technique has the potential to significantly reduce post-discharge costs.

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Section: Discharge Statusmentioning

confidence: 99%

Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique

Gofton

Chow

Olsen

et al. 2014

International Orthopaedics (SICOT)

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“…Currently, there is an opportunity for cost savings through more efficient use of PAC facilities due to the wide variation in discharge practices. 6,12 Discharging patients home instead of PAC inpatient facilities can save up to US$14,000 per EOC. 13 In fact, it has been demonstrated that extending a patient's hospital stay by an additional 5.2 days in an effort to discharge the patient directly home resulted in reduced overall costs and superior outcomes than THA recipients who were discharged to a PAC facility.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Patient-Reported Outcomes May Help Predict Discharge Disposition after Total Hip Arthroplasty

et al. 2019

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Patient-reported outcome (PRO) instruments are measures that allow for a standardized assessment of a patient's functional status, symptoms, and quality of life (QoL) through self-reported questionnaires. The purpose of this study was to assess the relationship between PRO scores, which measure patients' preoperative pain and functional status, and discharge disposition in the total hip arthroplasty (THA) population. The authors conducted a retrospective review of patients with a primary diagnosis of osteoarthritis who underwent THA at a single, urban, tertiary care center between September 2013 and August 2016. Patient demographics and preoperative PRO scores (Hip Disability and Osteoarthritis Outcome Score [HOOS] and EuroQol 5-Dimension [EQ-5D] questionnaire) were collected, and discharge disposition was categorized into the following two cohorts: THA recipients discharged to home and those discharged to a postacute care facility. When comparing PRO scores between the two groups, patients discharged home were found to have significantly higher average preoperative global EQ-5D, EQ-5D-QoL, HOOS activities of daily living (ADL), HOOS pain, HOOS sports, and HOOS symptoms scores. Patients discharged home trended toward higher HOOS QoL scores (28.1 vs. 22.6%), but this did not achieve significance (p < 0.08). The authors found a significant relationship between patients' baseline PRO scores and discharge disposition following THA. Patients discharged home had significantly higher preoperative PRO scores as measured by EQ-5D and HOOS. This demonstrates that patients with lower baseline PRO scores, indicating lower baseline function, may require additional care following surgery. These scores provide surgeons with an objective parameter that can assist in the planning and coordination of postoperative care. This study was a level III retrospective cohort.

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“…The decisive elements for readmission and revision surgery rates in the model are the initial rates obtained from the literature, 9,77,78 which change over time with patient outcomes/functionality after primary knee replacements (see Section 3 in the Appendix [MDIR] in Supplemental Materials). Patient outcomes/functionality are determined by standardizing range of motion and axial rotation for each type of implant to healthy knee performance, along with the average rate of condyle lift-off in early and late flexion for each type of implant.…”

Section: Readmissions and Revision Surgeriesmentioning

confidence: 99%

Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants

et al. 2019

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Objectives: To investigate the impact of insurance coverage on the adoption of customized individually made (CIM) knee implants and to compare patient outcomes and cost effectiveness of off-the-shelf and CIM implants. Methods: A system dynamics simulation model was developed to study adoption dynamics of CIM and meet the research objectives. The model reproduced the historical data on primary and revision knee replacement implants obtained from the literature and the Nationwide Inpatient Sample. Then the dynamics of adoption of CIM implants were simulated from 2018 to 2026. The rate of 90-day readmission, 3-year revision surgery, recovery period, time savings in operating rooms, and the associated cost within 3 years of primary knee replacement implants were used as performance metrics. Results: The simulation results indicate that by 2026, an adoption rate of 90% for CIM implants can reduce the number of readmissions and revision surgeries by 62% and 39%, respectively, and can save hospitals and surgeons 6% on procedure time and cut down cumulative healthcare costs by approximately $38 billion. Conclusions: CIM implants have the potential to deliver high-quality care while decreasing overall healthcare costs, but their adoption requires the expansion of current insurance coverage. This work presents the first systematic study to understand the dynamics of adoption of CIM knee implants and instrumentation. More broadly, the current modeling approach and systems thinking perspective could be used to consider the adoption of any emerging customized therapies for personalized medicine.Reports have indicated that patient satisfaction with off-the-shelf (OTS) implants can range from 75% to 92%. 12e18 Customized

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Correlation Between Physician Specific Discharge Costs, LOS, and 30-day Readmission Rates: An Analysis of 1,831 cases

Cited by 50 publications

References 20 publications

Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique

Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique

Preoperative Patient-Reported Outcomes May Help Predict Discharge Disposition after Total Hip Arthroplasty

Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants

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