Determining the True Cost to Deliver Total Hip and Knee Arthroplasty Over the Full Cycle of Care: Preparing for Bundling and Reference-Based Pricing

DiGioia, Anthony M.; Greenhouse, Pamela K.; Giarrusso, Michelle L.; Kress, Justina M.

doi:10.1016/j.arth.2015.07.013

Cited by 56 publications

(39 citation statements)

References 11 publications

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“…TDABC, a bottoms-up approach, uses process mapping to identify the types and costs of all personnel utilized in each step of a complete cycle of care [3], [4], [5], [6]. TDABC has previously been used to examine the costs of TJAs at individual sites [7], [8].…”

Section: Introductionmentioning

confidence: 99%

Variation in the cost of care for primary total knee arthroplasties

Haas¹,

Kaplan²

2017

Arthroplasty Today

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BackgroundThe study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates.MethodsHospital and physician personnel costs were calculated using time-driven activity-based costing. Consumable supply costs, such as the prosthetic implant, were calculated using purchase prices, and postacute care costs were measured using either internal costs or external claims as reported by each hospital.ResultsDespite having similar patient demographics and readmission and complication rates, the average cost of care for total knee arthroplasty across the hospitals varied by a factor of about 2 to 1. Even after adjusting for differences in internal labor cost rates, the hospital at the 90th percentile of cost spent about twice as much as the one at the 10th percentile of cost.ConclusionsThe large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.

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Section: Introductionmentioning

confidence: 99%

Variation in the cost of care for primary total knee arthroplasties

Haas¹,

Kaplan²

2017

Arthroplasty Today

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“…While there are different approaches to cost‐accounting, we applied time‐driven activity‐based costing (TD‐ABC) to measure the costs of performing CT of the abdomen/pelvis. The analysis combines traditional process maps with a financial cost accounting system, where every process required to complete imaging services is mapped, and the sum of all the costs of each step is the total cost of the procedure or imaging service.…”

Section: Measuring Imaging Costsmentioning

confidence: 99%

“…VDO dashboards enable providers to visualize the variations of cost, eg, substantial differences in imaging utilization among surgeons who care for patients under the same Medicare disease-related group (DRG). 27 While there are different approaches to costaccounting, 26 we applied time-driven activity-based costing (TD-ABC) [28][29][30][31][32][33] to measure the costs of performing CT of the abdomen/pelvis. The analysis combines traditional process maps with a financial cost accounting system, where every process required to complete imaging services is mapped, 28,31,[33][34][35] and the sum of all the costs of each step is the total cost of the procedure or imaging service.…”

Section: Measuring Imaging Costsmentioning

confidence: 99%

Enhancing Value of MRI: A Call for Action

Anzai

Minoshima

Lee

2018

Magnetic Resonance Imaging

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As national healthcare spending has spiraled out of control, payment reform that moves from volume to value‐based payment has been introduced as a practical solution. Under alternative value‐based payment models, physicians and clinical teams must deliver the best care possible at a lower cost. Medical imaging has changed the way we diagnose disease, evaluate severity, assess treatment effects, and provide biological insights for the pathophysiology of many diseases. Over the past 50 years, imaging techniques have become increasingly advanced—from X‐ray to computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and multi‐modal imaging. Advanced imaging such as MRI has given clinicians remarkable insights into medical conditions and saved innumerable lives. Under the value proposition, however, we must ask if each imaging study changes treatment decisions, improves patient outcomes, and is cost‐effective. Imaging research has been focused on developing new technologies and clinical applications to assess diagnostic accuracy. What is needed is the higher‐level technology assessment. In this article we review why we need to demonstrate the value of MRI, how we define value, what strategies can enhance MR value through partnership with various stakeholders, and how imaging scientists can contribute to healthcare delivery in the future. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:e40–e48.

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“…According to the Center for Disease Control's Inpatient Surgery Report, as of 2014 over 719,000 total knee replacements were performed on an annual basis; this number likely has since increased, as predicted by Losina et al (2012). As the number of TKA operations increases, so too has the overall costs associated such a high level of care (DiGioia, III, Greenhouse, Giarrusso, & Kress, 2015). As costs have increased, hospitals have been challenged by payers at all levels, including the government, to demonstrate greater accountability by delivering improved patient outcomes (Bechtel & Ness, 2010).…”

Section: Acknowledgementsmentioning

confidence: 99%

“…The Initial Reading 54 The Initial Notation 55 Identification and Development of Emergent Themes 56 Mapping Connections 57 Trustworthiness 58 Field Testing 58 Validation 59 Protection of Human Subjects 60 Conclusion 60 III, Greenhouse, Giarrusso, & Kress, 2015). A shorter stay for patients increases the demands on the patient in health and healthcare (Berwick & Hackbarth, 2012) as well as on providers, who must educate patients more quickly because opportunities for teaching at the bedside are significantly reduced.…”

Section: Acknowledgementsmentioning

confidence: 99%

experience of preoperative patient education for women preparing for and recovering from total knee replacement

Spooner¹

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Determining the True Cost to Deliver Total Hip and Knee Arthroplasty Over the Full Cycle of Care: Preparing for Bundling and Reference-Based Pricing

Cited by 56 publications

References 11 publications

Variation in the cost of care for primary total knee arthroplasties

Variation in the cost of care for primary total knee arthroplasties

Enhancing Value of MRI: A Call for Action

experience of preoperative patient education for women preparing for and recovering from total knee replacement

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