Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative

The Impact of Discharge Disposition on Episode-of-Care Reimbursement After Primary Total Hip Arthroplasty

“…Intraoperatively, cost-effectiveness studies have focused on improving surgical techniques, decreasing duration of surgery, and reducing implant cost [25–28]. Postoperative cost analyses have mainly focused on the cost of complications requiring emergency room visits, medical workup, readmissions, and revision surgery [17,29,30]. …”

“…Prior studies have evaluated this topic and found that discharge to a higher level of care is associated with a higher rate of readmissions [37]. Along this line, readmissions are a huge cost driver, with medical- and procedural-related readmissions costing an average of $11,682 and $27,979, respectively [29] A study by Kurtz et al [38] also identified readmission as a primary cost driver and concluded that nearly half of the total annual economic burden in the United States for readmissions after TJA was for a medical reason and unrelated to the joint arthroplasty procedure. Preoperatively identifying variables associated with increased cost can improve care pathways and perioperative optimization, particularly in the era of bundled payments.…”

Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality

“…To cover episode costs related to readmissions, profit margins would have to exceed 4.3% for primary THA, 8.3% for revision THA, and nearly 12% for revision TKA. Similarly, Clair et al [45] reported that medical-and procedural-related readmissions cost, on average, $11,682 and $27,979, respectively. Kurtz et al [46] also identified readmission as a primary cost driver and concluded that nearly half of the total annual economic burden in the USA for readmissions following TJA was for a medical reason and unrelated to the joint replacement procedure.…”

Quality and Value in an Evolving Health Care Landscape

“…22 Medicare is testing bundled payments with the Comprehensive Care for Joint Replacement Model, which is currently bundling payments for total joint arthroplasty in 67 metropolitan areas. 23 If this model were applied to CTR, for example, there would be one payment to the providers of surgery and postoperative management.…”