Bundled Payments in Total Joint Arthroplasty: Targeting Opportunities for Quality Improvement and Cost Reduction

Bozic, Kevin J.; Ward, Lorrayne; Vail, Thomas P.; Maze, Mervyn

doi:10.1007/s11999-013-3034-3

Cited by 389 publications

(222 citation statements)

References 8 publications

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“…Key findings included that hospital payments typically were the largest component of total episode payments (60%-80% of the total), payments to physicians typically were 12% to 15% of episode payments, and postacute payments were 5% to 10% of episode payments for most conditions [1]. Alternatively, Bozic et al [3] focused on total joint arthroplasty performed at a large academic medical center and found that postdischarge payments comprised 36% of total payments and 49% of patients were discharged to postacute care. Our analysis showed that there is substantial variation in episode-of-care payments for primary TKA across hospitals.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

Cram

Ravi

Vaughan-Sarrazin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Episode-of-care payments are defined as a single lump-sum payment for all services associated with a single medical event or surgery and are designed to incentivize efficiency and integration among providers and healthcare systems. A TKA is considered an exemplar for an episode-of-care payment model by many policymakers, but data describing variation payments between hospitals for TKA are extremely limited. Questions/purposes We asked: (1) How much variation is there between hospitals in episode-of-care payments for primary TKA? (2) Is variation in payment explained by differences in hospital structural characteristics such as teaching status or geographic location, patient factors (age, sex, ethnicity, comorbidities), and discharge disposition during the postoperative period (home versus skilled nursing facility)? (3) After accounting for those factors, what proportion of the observed variation remains unexplained? Methods We used Medicare administrative data to identify fee-for-service beneficiaries who underwent a primary elective TKA in 2009. After excluding low-volume hospitals, we created longitudinal records for all patients undergoing TKAs in eligible hospitals encompassing virtually all payments by Medicare for a 120-day window around the TKA (30 days before to 90 days after). We examined payments for the preoperative, perioperative, and postdischarge periods based on the hospital where the TKA was performed. Confounding variables were controlled for using multivariate analyses to determine whetherThe institution of one of the authors (PC) has received, during the study period, funding from the National Institutes of Health (K24 AR062133 and R01 AG033035). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that the institutional review board at the University of Iowa approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the University of Iowa, Iowa City, IA. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® differences in hospital payments could be explained by differences in patient demographics, comorbidity, or hospital structural factors. Results There was considerable variation in payments across hospitals. Median (interquartile range) hospital preoperative, perioperative, postdischarge, and 120-day payments for patients who did not experience a complication were USD 623 (USD 516-768), USD 13,119 (USD 12,668), USD 8020 (USD 6403-9933), and USD 21,870 (USD 19,041), respectively. Variation cannot be explained by differences in hospital structure. Median (interquartile range) episode payments were greater for hospitals in the Northeast (USD 26,291 [22,323

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Section: Discussionmentioning

confidence: 99%

“…Likewise, healthcare systems and physicians, who will assume ''risk'' under bundled payment models, need to have access to and understand their internal costs for each condition. Currently, there are few published studies describing episode-of-care payments for specific diagnoses and conditions [1,3,8].…”

Section: Introductionmentioning

confidence: 99%

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

Cram

Ravi

Vaughan-Sarrazin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Under this model, no additional compensation is provided for complications or unplanned readmissions occurring within the window. Bozic et al recently reviewed payments for all total joint replacements (TJRs) performed at a single institution to examine the financial impact of bundling with this model [1]. They found 37 % of the costs incurred for primary TJRs coded MS-DRG 470 were attributable to post-discharge activities, and that over 80 % of those costs were attributable to unplanned readmissions and discharging patients to post-acute care facilities.…”

Section: Introductionmentioning

confidence: 99%

Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique

Gofton

Chow

Olsen

et al. 2014

International Orthopaedics (SICOT)

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Purpose Recent studies have reported nearly 40 % of costs associated with a 30-day episode-of-care for total joint replacements are due to post-discharge activities and 81 % of those are specifically due to unplanned readmissions and discharging patients to post-acute care facilities. The purpose of this study was to determine these two key variables for total hip arthroplasty (THA) patients implanted using a tissuesparing surgical technique and to see how these values compare to those previously reported in the United States. Methods The healthcare databases at three institutions were searched for primary THA patients implanted using the supercapsular percutaneously-assisted total hip (SuperPath) surgical technique between January 2013 and July 2014. Data elements included 30-day all-cause readmission rate, discharge status, transfusion rate, complications, and length of stay (LOS). Results Data were available for 479 THAs. The 30-day allcause readmission rate, transfusion rate, and average LOS was 2.3, 3.3 %, and 1.6 days, respectively. Over 91 % of patients were discharged routinely home, 4.1 % to skilled nursing facilities, 3.8 % to home health care, and 0.6 % to inpatient rehabilitation facilities. Complications included dislocation (0.8 %), periprosthetic fracture (0.8 %), and deep vein thrombosis (0.2 %). There were no infections reported. Conclusions Patients implanted using this tissue-sparing technique experienced reduced 30-day all-cause readmission rates (2.3 % vs. 4.2 %) and more were routinely discharged home (91.5 % vs. 27.3 %) than have been previously reported for patients in the United States. Use of this tissue-sparing technique has the potential to significantly reduce post-discharge costs.

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“…All four models use the current MS-DRG system to categorize patients. The American Association of Hip and Knee Surgeons has created a bundled payment task force to identify issues in the system specific to hip and knee surgeons and to aid in the eventual transition [8,18]. In addition, many private health plans, which cover patients of all ages, use a MS-DRG-based model for reimbursement.…”

Section: Discussionmentioning

confidence: 99%

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

Samuel

Webb

Lukasiewicz

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Medicare currently reimburses hospitals for inpatient admissions with ''bundled'' payments based on patient Diagnosis-related Groups (DRGs) regardless of true hospital costs. At present, DRG 536 (fractures of the hip and pelvis) includes a broad spectrum of patients with orthopaedic trauma, likely with varying inpatient resource utilization. With the growing incidence of fractures in the elderly, inadequate reimbursements from Medicare for certain patients with DRG 536 may lead to growing financial strain on healthcare institutions caring for these patients with higher costs. Questions/purposes The purposes of the study were to determine whether (1) inpatient length of stay; (2) intensive care unit stay; and (3) ventilator time differ among subpopulations with Medicare DRG 536. Methods A total of 56,683 patients, 65 years or older, with fractures of the hip or pelvis were identified in the 2011 and 2012 National Trauma Data Bank. This clinical registry contains data on trauma cases from more than 900 participating trauma centers, allowing analysis of resource One of the authors certifies that he (AMS) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Orthopaedic Trauma Association (Rosemont, IL). One of the authors certifies that he (JML) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Bone Therapeutics (Charleroi, Belgium), an amount of less than USD 10,000 from Kuros (Zurich,Switzerland), an amount of less than USD 10,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Emcyte (Fort Myers, FL, USA), an amount of less than USD 10,000 from Royal Marketing Inc (Westmount, Quebec, Canada), an amount of less than USD 10,000 from Graftys (Chicago, IL, USA), an amount of USD 100,000-USD 1,000,000 from Merck (Kenilworth, NJ, USA), and an amount of USD 100,000-USD 1,000,000 from National Institutes of Health (Bethesda, MD, USA). One of the authors certifies that he (JNG) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Bioventus (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Harvard Clinical Research Institute (Boston, MA, USA), an amount of USD 10,000-USD 100,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), an amount of USD 10,000-USD 100,000 from Stryker (Kalamazoo, MI, USA), an amount of less than USD 10,000 from Affinergy (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Alphatec (Carlsbad, CA), an amount of less than USD 10,000 from DePuy (Raynham, MA, USA), an amount of less than USD 10,000 from Powered Research (Research Triangle Park, NC, USA), an amount of less than USD 10,000 from KCI (San Antonio, TX, USA), an amount of less than USD 10,000...

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Bundled Payments in Total Joint Arthroplasty: Targeting Opportunities for Quality Improvement and Cost Reduction

Cited by 389 publications

References 8 publications

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

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