Hip Fractures and the Bundle: A Cost Analysis of Patients Undergoing Hip Arthroplasty for Femoral Neck Fracture vs Degenerative Joint Disease

Grace, Trevor; Patterson, Joseph T.; Tangtiphaiboontana, Jennifer; Krogue, Justin D.; Vail, Thomas P.; Ward, Derek

doi:10.1016/j.arth.2018.01.071

Cited by 32 publications

(22 citation statements)

References 21 publications

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“…7,8 Hip fracture costs and reimbursement are commonly analyzed as separate entities. 9,10 However, a 1998 study compared hospital costs to CMS reimbursement in hip fracture patients. The study found reimbursement of the previous DRG system to be inadequate to compensate for the hospital costs.…”

Section: Introductionmentioning

confidence: 99%

Financial Implications for the Treatment of Medicare Patients With Isolated Intertrochanteric Femur Fractures: Disproportionate Losses Among Healthier Patients

Kelly

Parikh

McCreary

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: With an aging American public, the rising incidence of geriatric hip fractures provides a significant impact on the financial sustainability for hospitals. To date, there is little research comparing reimbursement to hospital costs for geriatric hip fracture treatment. The purpose of this study is to compare hospital costs to reimbursement for patients treated surgically with an isolated intertrochanteric femur fracture, insured by the Center of Medicare and Medicaid Services (CMS). Materials and Methods: A retrospective review at an urban, academic, level 1 trauma center was conducted for 287 CMS-insured intertrochanteric femur fracture patients between 2013 and 2017. The total cost of care was determined using our hospital’s cost accounting system. The total reimbursement was determined from the CMS inpatient prospective payment system, based upon the Medical-Severity Diagnosis-Related Grouping (MS-DRG). Results: In this patient population, the average CMS reimbursement was US$19 049 ± 7221 and the average cost of care was US$19 822 ± 8078. This yielded a net deficit of US$773/patient and US$220 417 in total. The average reimbursement and cost for the less comorbid patients (MS-DRG weight < 2.5, n = 215) was US$16 198 ± 3983 and US$17 764 ± 5628, respectively, yielding an average net deficit of US$1566/patient. For the more comorbid patients (MS-DRG weight > 2.5, n = 72) the mean reimbursement and cost were US$27 796 ± 3944 and US$26 180 ± 10 880, respectively, yielding an average net profit of US$1616/patient. Discussion: There are disproportionate average losses in healthier patients undergoing surgical treatment of intertrochanteric femur fractures at our institution. A deficit in less comorbid patients indicates a discontinuity of inpatient health-care costs with MS-DRG-weighted reimbursement in the setting of geriatric intertrochanteric femur fractures. Conclusions: To maintain hospitals’ financial sustainability and health-care accessibility; costing and reimbursement models need adjusting to properly compensate the treatment of geriatric intertrochanteric femur fractures. Level of Evidence: Diagnostic level IV.

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Section: Introductionmentioning

confidence: 99%

Financial Implications for the Treatment of Medicare Patients With Isolated Intertrochanteric Femur Fractures: Disproportionate Losses Among Healthier Patients

Kelly

Parikh

McCreary

et al. 2020

Geriatr Orthop Surg Rehabil

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“…As alternative payment models continue to evolve, there is a continued need to evaluate different indications to optimize bundles [1]. As evidenced by the differences in complication rates of THA for femoral neck fractures compared with primary OA [16], different indications for THA have different risk profiles [2,3]. Therefore, we sought to evaluate DDH, one of the leading causes of secondary OA to determine whether additional risk stratification is appropriate for this group of THA patients.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, there has been increasing interest in alternative payment models, such as bundled payments, in total hip arthroplasty (THA) [1]. As bundled payments continue to evolve, recent studies have shown that not all indications for THA belong in the same bundle owing to differences in the patient population and clinical outcomes [2,3]. Consequently, it is important to continue to evaluate other indications for THA to determine optimal bundles [4].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the purpose of this study was to (1) evaluate the differences in demographics of patients undergoing THA for DDH and primary OA; (2) evaluate differences in short-term perioperative and postoperative outcomes between the two groups via a propensity-matched pair analysis compiled from the National Surgical Quality Improvement Program (NSQIP) database; (3) evaluate procedural THA valuation between the two cohorts. We hypothesize that the two cohorts are different, therefore, necessitating added risk stratification for patients undergoing primary THA for hip dysplasia in bundled payment models.…”

Section: Introductionmentioning

confidence: 99%

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Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis

et al. 2020

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Background: The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program to compare the perioperative and postoperative outcomes after total hip arthroplasty (THA) for DDH and primary OA via a propensity-matched pair analysis and the valuation of THA between both groups. Material and Methods: All patients who underwent THA between 2008 and 2016 were identified from National Surgical Quality Improvement Program database via the current procedural terminology (CPT) code. Patients were further identified and stratified based on International Statistical Classification of Diseases and Related Health Problemse9/International Statistical Classification of Diseases and Related Health Problemse10 diagnosis codes for primary OA (n ¼ 115,166) and DDH (n ¼ 603), which included codes for congenital hip dislocation, hip dysplasia, or juvenile osteochondrosis. Demographic variables were used to create 557 propensity-matched pairs. Results: The DDH group was associated with a significantly longer operative time (120.3 vs 95.9 min), higher postoperative transfusion rate (12% vs 6.6%), and longer hospital length of stay (2.8 vs 2.5 days) compared with the primary OA group (P < .001, P < .001, and P ¼ .002, respectively). There were no statistically significant differences found between the two groups with respect to inpatient complications, discharge disposition (P ¼ .123), readmissions (P ¼ .615), or reoperations (P ¼ .404). Conclusions: Health policy makers should be cognizant of the higher complexity of THA for DDH when determining whether DDH and primary OA should be in the same bundle. Owing to the limitations of our data set, all the observed associations are likely an underestimate of the true risk posed to patients with severe DDH, as these patients were unable to be stratified in the present analysis.

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“…As evidenced by findings from numerous studies (Table 2), THAs being performed for hip fractures, as compared to those being performed for hip osteoarthritis, are associated with significantly higher odds of longer length of stay, postoperative complications, readmissions, reoperations, nonhome discharges, and mortality. [19][20][21][22][23][24] Although the CJR model risk-adjusts prospective payments based on fracture status (https://innovation.cms.gov/initiatives/CJR), the BPCI-LEJR model for the same DRG codes has not implemented any robust risk-adjustment methodology that accounts for the indication/ cause of surgery.…”

Section: Current Experiences With the Hip Fracture Bpci Bundle (Drg 4mentioning

confidence: 99%

The “Hip Fracture” Bundle—Experiences, Challenges, and Opportunities

Malik

Khan

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: With growing popularity and success of alternative-payment models (APMs) in elective total joint arthroplasties, there has been recent discussion on the probability of implementing APMs for geriatric hip fractures as well. Significance: Despite the growing interest, little is known about the drawbacks and challenges that will be faced in a stipulated “hip fracture” bundle. Results: Given the varying intricacies and complexities of hip fractures, a “one-size-fits-all” bundled payment may not be an amenable way of ensuring equitable reimbursement for participating physicians and hospitals. Conclusions: Health-policy makers need to advocate for better risk-adjustment methods to prevent the creation of financial disincentives for hospitals taking care of complex, sicker patients. Hospitals participating in bundled care also need to voice concerns regarding the grouping of hip fractures undergoing total hip arthroplasty to ensure that trauma centers are not unfairly penalized due to higher readmission rates associated with hip fractures skewing quality metrics. Physicians also need to consider the launch of better risk-stratification protocols and promote geriatric comanagement of these patients to prevent occurrences of costly adverse events.

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Hip Fractures and the Bundle: A Cost Analysis of Patients Undergoing Hip Arthroplasty for Femoral Neck Fracture vs Degenerative Joint Disease

Cited by 32 publications

References 21 publications

Financial Implications for the Treatment of Medicare Patients With Isolated Intertrochanteric Femur Fractures: Disproportionate Losses Among Healthier Patients

Financial Implications for the Treatment of Medicare Patients With Isolated Intertrochanteric Femur Fractures: Disproportionate Losses Among Healthier Patients

Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis

The “Hip Fracture” Bundle—Experiences, Challenges, and Opportunities

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