Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study

McLawhorn, Alexander S.; Schairer, William W.; Schwarzkopf, Ran; Halsey, David; Iorio, Richard; Padgett, Douglas E.

doi:10.1016/j.arth.2017.11.064

Cited by 21 publications

(18 citation statements)

References 27 publications

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“…Due to its retrospective nature confounding factors such as patient expectations were not investigated. McLawhorn et al and Qun et al found that patients who underwent cTHA required more transfusions, had longer operative times and length of hospital stays, and more often had non-home bound discharge [ 13 , 15 ]. Due to the absence of these data, no cost analysis could be made.…”

Section: Discussionmentioning

confidence: 99%

“…Attempts have been made to determine the success of cTHA among pTHA and rTHA, as this has implications for patient consenting and institutional reimbursement [ 10 – 17 ]. It has been suggested that a cTHA should be considered an rTHA, but also that it is a distinct entity with outcomes in between pTHA and rTHA [ 13 , 14 , 16 ]. Interpreting these studies is difficult, as matched cohort analyses are rare, follow-up differs between groups, but most importantly because of the fact that very diverse groups of cTHA’s are compared to very diverse groups of rTHA’s [ 10 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

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RETRACTED ARTICLE: The majority of conversion total hip arthroplasties can be considered a primary replacement: a matched cohort study

et al. 2020

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Background and study aims The success of conversion total hip arthroplasty (THA) among primary THA and revision THA remains unclear. We hypothesized that most conversion THA’s can be performed using primary implants and will have an uncomplicated post-operative course. Materials and methods Thirty-six patients (23 females, mean age 68,0y) who underwent conversion THA for failed interventions for proximal femur fractures in the period 2008–2018 were matched sequentially against patients of the same sex and age who underwent primary THA or revision THA. Data were collected on implants used, major complications, and mortality. PROMs used included the Western Ontario and McMaster Osteoarthritis Index, Harris Hip Score, Visual Analogue Scale and the EQ-5D Health Questionnaire. Results Seventy-two percent of patients who underwent conversion THA were treated with primary implants and never suffered from a major complication. PROMs were excellent for this group of patients. The distinction primary/conversion/revision THA could not explain differences in outcomes; however, the necessity of using revision implants and the development of major complications could. Conclusions The majority of conversion total hip arthroplasties can be considered a primary replacement. Predicting outcomes for THA should focus on patient frailty and technical difficulties dealing with infection, stability and loss of bone stock and should discard the conversion versus revision terminology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

RETRACTED ARTICLE: The majority of conversion total hip arthroplasties can be considered a primary replacement: a matched cohort study

et al. 2020

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“…Traditionally, risk adjustment has been inadequate for the sickest patients, leading to some hospitals incurring large losses to treat these patients and decreasing these patient's access to care. 10,[25][26][27] The results of our study indicates that MS-DRG reimbursement system results in under reimbursement for treating the least sick patients (MS-DRG weight < 2.5, average loss ¼ US$1566, n ¼ 215) and over reimbursement for treating the sickest patients (MS-DRG weight > 2.5, average profit ¼ US$1616, n ¼ 72) at our institution. The generalizability of this data is indeterminate.…”

Section: Discussionmentioning

confidence: 74%

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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“…5 However, studies reveal that these value-based bundled payments are often not appropriately adjusted for increased risk and procedural complexities; efforts to do so even with existing evidence are lacking. 6-8 As a result, surgeons are increasingly disincentivized to operate on high-risk patients, and patient access to needed surgery may become restricted. Our intention is to study the trend of practice and challenge the assumption that increased comorbidities may be associated with higher incidence of complications.…”

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confidence: 99%

Trends in Inpatient Resource Utilization and Complications Among Total Joint Arthroplasty Recipients: A Retrospective Cohort Study

et al. 2018

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Introduction:Joint arthroplasty practice is highly dynamic to adapt to economic changes and advances in medicine. This study provides updates of the current perioperative practice on healthcare resource utilization.Methods:The study included total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty within the healthcare cost and utilization project New York State database from 2007 to 2013 (ie, 202,100, 127,872, and 8858 cases, respectively).Results:A higher proportion of sicker patients were prevalent over time. The length of stay decreased continuously. However, total hospital charges increased after adjusting for inflation. The incidence of wound infection and transfusion decreased steadily over time, whereas acute renal failure has been on the rise. There was an increased utilization of echocardiography, while decreased among other resources.Discussion:Total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty changed toward sicker patients with shorter length of stay, fewer complications, and less resource utilization. However, overall costs increased over time.

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Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study

Cited by 21 publications

References 27 publications

RETRACTED ARTICLE: The majority of conversion total hip arthroplasties can be considered a primary replacement: a matched cohort study

RETRACTED ARTICLE: The majority of conversion total hip arthroplasties can be considered a primary replacement: a matched cohort study

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

Trends in Inpatient Resource Utilization and Complications Among Total Joint Arthroplasty Recipients: A Retrospective Cohort Study

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