Health Policy and EconomicsWhat is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?
Section snippets
Methods
Our institution began a bundled payment program with The Center for Medicare Services (CMS), which includes the inpatient stay in the acute care hospital and all related services during the episode. The episode we selected ends 90 days after hospital discharge. Only unilateral primary procedures are included. We reviewed the costs obtained for post-acute care from our Bundled Payment Claims Data received from CMS, where all costs for the episode are captured and reconciled by CMS, for 2 groups:
Results
Figure 2 demonstrates that using our cost data, patients could be kept for up to 5.2 extra days of acute care hospitalization, if they are discharged to home with services rather than an inpatient rehabilitation facility and still have a lower cost of care.
Discussion
In this analysis, we examined the cost to bundled payment providers of 2 post-acute care strategies, discharge to a rehabilitation center, and discharge home with services. The decision analysis data demonstrated that because the cost of additional acute care hospital days is relatively small and the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for up to 5.2 days results in an overall lower cost than discharge to a post-acute
Conclusion
Bundled payment models entail increased financial responsibility for providers of total hip and knee arthroplasty for up to 90 days after surgery. Traditional cost transfer strategies with high utilization of inpatient rehabilitation facilities have a significant impact on the cost of bundled episode of care, and efforts to minimize these costs while maintaining or improving quality are warranted. One strategy to decrease costs while maintaining or improving quality is to discharge only
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Cited by (0)
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.2016.05.024.