Cost Analysis of Medicare Patients with Varying Complexities Who Underwent Total Knee Arthroplasty

Abstract

The effort to reduce overall healthcare costs may affect more complex patients, as their pre- and postoperative care can be substantially involved. Therefore, the purpose of this study was to use a large nationwide insurance database to compare (1) costs, (2) reimbursements, and (3) net losses of 90-day episodes of care (EOC) for total knee arthroplasty (TKA) patients according to Elixhauser's comorbidity index (ECI) scores. All TKAs performed between 2005 and 2014 in the Medicare Standard Analytic Files were extracted from the database and stratified based on ECI scores, ranging from 1 to 5. ECI 1 patients served as the control cohort, while ECI 2, 3, 4, and 5 patients were considered study cohorts. Each study cohort and control cohort were matched based on age and sex, resulting in a total of 715,398 patients included for analysis. Total EOC costs, reimbursements, and total net losses (defined as total EOC costs minus total EOC reimbursements) were compared between the cohorts. Overall, total EOC costs increased with ECI. For example, compared with the matched ECI 1 cohorts, the total EOC costs for ECI 5 patients ($56,589.19 vs. $51,747.54) were significantly greater (p < 0.01). Although reimbursements increased with increasing ECI, so did net losses. The net losses for ECI 5 patients were greater than that for ECI 1 patients ($42,309.39 vs. $40,007.82). The bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR) are alternative payment models that might de-incentivize treatment of more complex patients. Our study found that despite increasing reimbursements, overall costs, and therefore net losses, were greater for more complex patients with higher ECI scores.

Comparing Precision Machine Learning With Consumer, Quality, and Volume Metrics for Ranking Orthopedic Surgery Hospitals: Retrospective Study

“…This finding is perhaps not surprising, given the complexity of surgical patients and the variations in case mixes, resources, training, and other organizational characteristics of hospitals that lead to facilities performing well or poorly for specific individuals. Prior research has shown that patient complexity is strongly correlated with outcomes in elective surgeries, such as total knee arthroplasty [34]. Bozic et al [35] also found considerable variation in respective patient population acuities of hospitals performing elective hip and knee replacements and a fourfold difference in risk-adjusted complication rates [35].…”

What’s New in Adult Reconstructive Knee Surgery

“…A large nationwide insurance database study revealed that net losses were greater for patients with higher Elixhauser Comorbidity Index (ECI) scores 1 . The U.S. Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) payment models may de-incentivize the treatment of sicker patients.…”

Increasing Patient Complexity Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Medical Complications Following Primary 1- to 2-Level Lumbar Fusion

“…3 This is an extremely important trend to explore, as patient complexity significantly influences complication rates as well as overall hospital costs. [4][5][6][7][8][9][10][11][12] The accuracy of comorbidity indices that rely on administrative data is therefore frequently evaluated, and both national and international studies have shown that comorbidity indices can predict complication rates and adverse outcomes. [4][5][6][7][8][9][10][13][14][15][16][17][18][19][20][21][22][23] As the volume of LF procedures performed, patient age and patient complexity increase, it is necessary for hospitals to implement risk stratification methods to accurately predict patient outcomes.…”

“…[4][5][6][7][8][9][10][11][12] The accuracy of comorbidity indices that rely on administrative data is therefore frequently evaluated, and both national and international studies have shown that comorbidity indices can predict complication rates and adverse outcomes. [4][5][6][7][8][9][10][13][14][15][16][17][18][19][20][21][22][23] As the volume of LF procedures performed, patient age and patient complexity increase, it is necessary for hospitals to implement risk stratification methods to accurately predict patient outcomes. [1][2][3] Perhaps the most widely utilized comorbidity index for administrative database studies is the Elixhauser Comorbidity Index (ECI).…”