Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Courtney, P. Maxwell; Ashley, Blair; Hume, Eric; Kamath, Atul F.

doi:10.1007/s11999-016-4953-6

Cited by 77 publications

(43 citation statements)

References 18 publications

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“…surgeons because these serve as important measures of quality and correlate with total episode-of-care costs [9,10,11,13]. Our results suggest that 90-day readmission rates may be lower in the highest-volume institutions; however, 90-day reoperation rates were not different.…”

Section: Discussionmentioning

confidence: 68%

What Is the Association Between Hospital Volume and Complications After Revision Total Joint Arthroplasty: A Large-database Study

Ricciardi

Liu

Qiu

et al. 2019

Clin Orthop Relat Res

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Background Studies of primary total joint arthroplasty (TJA) show a correlation between hospital volume and outcomes; however, the relationship of volume to outcomes in revision TJA is not well studied. Questions/purposes We therefore asked: (1) Are 90-day readmissions more likely at low-volume hospitals relative to high-volume hospitals after revision THA and TKA? (2) Are in-hospital and 90-day complications more likely at low-volume hospitals relative to high-volume hospitals after revision THA and TKA? (3) Are 30-day mortality rates higher at low-volume hospitals relative to highvolume hospitals after revision THA and TKA? Methods Using 29,948 inpatient stays undergoing revision TJA from 2008 to 2014 in the Statewide Planning and Research Cooperative System (SPARCS) database for New York State, we examined the relationship of hospital revision volume by quartile and outcomes. The top 5 percentile of hospitals was included as a separate cohort. Advantages of the SPARCS database include comprehensive catchment of all cases regardless of payer, and the ability to track each patient across hospital admissions at different institutions within the state. The outcomes of interest included 90-day all-cause readmission rates and 30-and 90-day reoperation rates, postoperative complication rates, and 30-day mortality rates. The initial cohort that met the MS-DRG and ICD-9 criteria consisted of 30,354 inpatient stays for revision hip or knee replacements. Exclusions included patients with a missing patient identifier (n = 221), missing admission or discharge dates (n = 5), and stays from hospitals that were closed during the study period (n = 180). Our final analytic cohort comprised 29,948 inpatient stays for revision hip and knee replacements from 25,977 patients who had nonmissing data points for the variables of interest. Outcomes were adjusted for underlying hospital, surgeon, and patient confounding variables. The analytic cohort included observations from 25,977 patients, 138 hospitals, 929 surgeons, 14,130 revision THAs, 11,847 revision TKAs, 15,341 female patients (59% of cohort). Each author certifies that neither he or she, nor any member of his or her immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Section: Discussionmentioning

confidence: 68%

What Is the Association Between Hospital Volume and Complications After Revision Total Joint Arthroplasty: A Large-database Study

Ricciardi

Liu

Qiu

et al. 2019

Clin Orthop Relat Res

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“…Because the economic and clinical burden of revision TKA is projected to increase [4,6,20], it has become a target for cost reduction for payers such as the CMS. Since alternative payment models have become popular to reduce episode-of-care costs in primary arthroplasty [5,[14][15][16]23], some centers are now participating in bundled payment arrangements for revision TKA [9]. A recent survey of adult reconstruction surgeons, however, reports that the top concern regarding bundled payment models is problems with access to care for patients who utilize more resources [18].…”

Section: Introductionmentioning

confidence: 99%

Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA

Courtney

Boniello

Valle

et al. 2018

Clin Orthop Relat Res

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Background The Medicare Access and CHIP Reauthorization Act of 2015 provides the framework to link reimbursement for providers based on outcome metrics. Concerns exist that the lack of risk adjustment for patients undergoing revision TKA for an infection may cause problems with access to care. Questions/purposes (1) After controlling for confounding variables, do patients undergoing revision TKA for infection have higher 30-day readmission, reoperation, and mortality rates than those undergoing revision TKA for aseptic causes? (2) Compared with patients undergoing revision TKA who are believed not to have infections, are patients undergoing revision for infected TKAs at increased risk for complications? Methods We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients undergoing revision TKA from 2012 to 2015 identified by Current Procedural Terminology (CPT) codes 27486, 27487, and 27488. Of the 10,848 patients identified, four were excluded with a diagnosis of malignancy (International Classification of Diseases, 9th Revision code 170.7, 170.9, 171.8, or 198.5). This validated, national database records short-term outcome data for inpatient procedures and does not rely on administrative coding data. Demographic variables, comorbidities, and outcomes were Each author certifies that neither he, nor any member of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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“…In contrast, a study by Courtney et al 19 found that increased comorbidities were not associated with greater EOC costs. The group found that Charlson's comorbidity index (CCI) scores of 3 or greater were not a significant risk factor for EOC costs in the upper quartile which was greater than $44,564 (OR: 0.81; 95% CI: 0.32-2.07; p ¼ 0.665).…”

Section: Discussionmentioning

confidence: 83%

Cost Analysis of Medicare Patients with Varying Complexities Who Underwent Total Knee Arthroplasty

et al. 2019

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The effort to reduce overall healthcare costs may affect more complex patients, as their pre- and postoperative care can be substantially involved. Therefore, the purpose of this study was to use a large nationwide insurance database to compare (1) costs, (2) reimbursements, and (3) net losses of 90-day episodes of care (EOC) for total knee arthroplasty (TKA) patients according to Elixhauser's comorbidity index (ECI) scores. All TKAs performed between 2005 and 2014 in the Medicare Standard Analytic Files were extracted from the database and stratified based on ECI scores, ranging from 1 to 5. ECI 1 patients served as the control cohort, while ECI 2, 3, 4, and 5 patients were considered study cohorts. Each study cohort and control cohort were matched based on age and sex, resulting in a total of 715,398 patients included for analysis. Total EOC costs, reimbursements, and total net losses (defined as total EOC costs minus total EOC reimbursements) were compared between the cohorts. Overall, total EOC costs increased with ECI. For example, compared with the matched ECI 1 cohorts, the total EOC costs for ECI 5 patients ($56,589.19 vs. $51,747.54) were significantly greater (p < 0.01). Although reimbursements increased with increasing ECI, so did net losses. The net losses for ECI 5 patients were greater than that for ECI 1 patients ($42,309.39 vs. $40,007.82). The bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR) are alternative payment models that might de-incentivize treatment of more complex patients. Our study found that despite increasing reimbursements, overall costs, and therefore net losses, were greater for more complex patients with higher ECI scores.

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Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Cited by 77 publications

References 18 publications

What Is the Association Between Hospital Volume and Complications After Revision Total Joint Arthroplasty: A Large-database Study

What Is the Association Between Hospital Volume and Complications After Revision Total Joint Arthroplasty: A Large-database Study

Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA

Cost Analysis of Medicare Patients with Varying Complexities Who Underwent Total Knee Arthroplasty

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