Elsevier

The Journal of Arthroplasty

Volume 31, Issue 9, September 2016, Pages 1862-1865
The Journal of Arthroplasty

Health Policy and Economics
Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative

https://doi.org/10.1016/j.arth.2016.02.029Get rights and content

Abstract

Background

The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA).

Methods

From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed.

Results

Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682.

Conclusion

Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts.

Section snippets

Methods

From January 2013 to December 2013, all Medicare patients undergoing either primary THA or TKA at our institution were enrolled in the BPCI Initiative. The BPCI Initiative agreement included all patients assigned to Medical Severity–Diagnosis-Related Groups: 469 and 470 patients undergoing primary THA or TKA. CMS followed all patients enrolled in the BPCI Initiative throughout the 90-day period after surgery. This included TKA, THA, partial hip arthroplasty, and partial or total hip resurfacing

Results

A total of 664 Medicare patients received either a THA or TKA and were enrolled in the BPCI Initiative (357 THAs, 307 TKAs) in 2013. Eighty readmissions in 69 of the 664 patients (10%) occurred within 90 days. Fifty-three readmissions (45 patients) were identified after THA (66% of all readmissions, ages 49-91, 18 males, and 28 females). The overall readmission rate after THA was 13%. Twenty-seven readmissions (24 patients) were identified after TKA (34% of all readmissions, ages 47-83, 7

Discussion

In this report, we identified the cost burden of readmissions after primary THA and TKA in a model 2 bundled payment agreement. CMS tracks and reports all readmissions of patients participating in the BPCI Initiative occurring within the United States. This enables participating institutions, such as ours, to know with certainty the CMS reimbursement and number of readmissions of their arthroplasty patients regardless of where the readmission occurs. The orthopedic literature is currently

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The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.02.029.

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