Health Policy and EconomicsThe Association Between Hospital Length of Stay and 90-Day Readmission Risk Within a Total Joint Arthroplasty Bundled Payment Initiative
Section snippets
Methods
This study was conducted as part of an existing quality control initiative to evaluate our performance in the type 2 lower extremity joint arthroplasty Bundled Program for Care Improvement (BPCI). We analyzed the prospectively collected data of all patients treated with primary THA or TKA at our institution that had insurance coverage consisting of Medicare part A + B or Railroad Medicare and followed them through their 90 days episodes of care. We used data from only a single high-volume
Results
Our analysis included 1329 patients. Eighty-one (6.1%) of 1248 patients were readmitted within 90 days of the index procedure. Patients were mostly female, older, white, non-Hispanic, and nonsmokers (Table 1). Univariate analysis demonstrated that readmitted patient had longer average LOS (3.81 ± 2.0 vs 2.10 ± 1.3 days, P < .001). Readmitted patients on average were older (73.7 ± 8.0 vs 71.7 ± 8.1 years, P = .024), had higher ASA scores (P = .009), underwent TKA (P = .043), and were more likely
Discussion
We found that a longer LOS is associated with a greater chance of 90-day post-discharge readmission for patients undergoing lower extremity total joint arthroplasty (LETJA) in our BPCI program. As of April 1, 2016, CMS requires mandatory participation in its CJR program for 33% of all hospitals performing LETJAs. These hospitals are selected at random [7]. The CJR is nearly identical to type 2 BPCI for LETJA. Because these reimbursement models include target 90-day prices (monetary amounts
Conclusion
Unplanned readmissions decrease health care value. With changing reimbursement models, health care providers are given more responsibility to decrease readmission rates for patients following TJA of the lower extremity. Our results indicate that increased LOS is a risk factor for readmission and care pathways that recognize and intervene in these patients should be developed and evaluated in order to try to reduce readmissions in this patient group.
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2021, Journal of ArthroplastyCitation Excerpt :Our results suggest that utilizing NA as an alternative to GA for primary direct anterior approach THA patients in an institution with established rapid recovery protocols may decrease the length of stay and improve postoperative outcomes. Previous studies have associated a longer length of stay with higher complication and readmission rates [17]. With an average cost of ~$2000 per day for THA patients, even a modest decrease in length of stay can result in significant cost savings for the institution [18].
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.2016.09.005.