Elsevier

The Journal of Arthroplasty

Volume 31, Issue 12, December 2016, Pages 2710-2713
The Journal of Arthroplasty

Health Policy and Economics
What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

https://doi.org/10.1016/j.arth.2016.05.024Get rights and content

Abstract

Background

The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies.

Methods

We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility.

Results

The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted.

Conclusion

The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy.

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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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.

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