Bundled payments in total joint arthroplasty and spine surgery

Sullivan, Rashad; Jarvis, Landry D.; O’Gara, Tadhg; Langfitt, Maxwell K.; Emory, Cynthia L.

doi:10.1007/s12178-017-9405-8

Cited by 84 publications

(31 citation statements)

References 15 publications

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“…[37][38][39] Identifying preoperative variables associated with increased cost can improve care pathways and perioperative optimization particularly in the era of bundled payments. 40 With increased knowledge of factors that affect the economic burden of procedures, newer strategies in preoperative optimization and postoperative care can be pioneered addressing patient comorbidities. This added effort may make it possible to improve patient care while decreasing costs in the current health care system and ultimately be able to customize bundles for patients based on their health profile, creating the optimal bundle.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

et al. 2018

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Medical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using analysis of variance for reimbursements for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients was identified as having undergone primary TKA between 2007 and 2015. The mean entire episode-of-care reimbursement was $23,701 (range: $21,294-26,299; standard deviation [SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766), morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361), and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative optimization for patients with medical comorbidities undergoing TKA is highly recommended and may reduce perioperative complications, improve patient outcome, and ultimately reduce cost.

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Section: Discussionmentioning

confidence: 99%

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

et al. 2018

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“…[1][2][3][4][5] The total cost of ACDF surgery varies, and spine surgeons are under more pressure to minimize the cost of surgery. [6][7][8][9] In a study investigating variability in the cost of ACDF surgery, the cost of surgery ranged from $26 653 to $129 220. 10 Bundled repayment provides a fixed fee for service for the surgical hospitalization and for the 90-day postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Dial

Esposito

Danilkowicz

et al. 2019

Global Spine Journal

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Study Design: Retrospective. Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF). Methods: Included ACDF patients from 2013 to 2017 at a single institution. Eligible patients were subset into LOS <2 and LOS ≥2 days, and no 90-day hospital readmission and yes 90-day hospital readmission. Patient and surgical factors were compared between the LOS and readmission groups. Multivariable logistic regression analysis was utilized to determine the association of independent factors with LOS and 90-day readmission rates. Results: Our sample included 1896 patients; 265 (14%) had LOS ≥2 days, and 121 (6.4%) had a readmission within 90 days of surgery. Patient and surgical factors associated with LOS included patient age ≥65 years (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.15-2.56), marriage (OR 0.57, 95% CI 0.43-0.79), private health insurance (OR 0.28, 95% CI 0.15-0.50), American Society of Anesthesiologists (ASA) score (OR 1.52, 95% CI 1.12-1.86), African American race (OR 1.95, 95% CI 1.38-2.72), and harvesting iliac crest autograft (OR 4.94, 95% CI 2.31-10.8). Patient and surgical factors associated with 90-day hospital readmission included ASA score (OR 1.81, 95% CI 1.32-2.49), length of surgery (OR 1.002, 95% CI 1.001-1.004), and radiculopathy as indication for surgery (OR 0.60, 95% CI 0.39-0.96). Conclusions: Extended LOS and 90-day hospital readmissions may lead to poorer patient outcomes and increased episode of care costs. Our study identified patient and surgical factors associated with extended LOS and 90-day readmission rates. In general, preoperative patient factors affected these outcomes more than surgical factors.

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“…[8][9][10] While BPCI have not yet been widely adopted for ACDF, there has recently been significant interest in the potential implications of the adoption of alternative payment methods in spine surgery. [11][12][13][14][15] A survey of predominantly academic-affiliated organizations employing over 110 spine surgeons found reservations and concerns, but an increased interest in the use of bundled payments for spine surgery reimbursement. 15 Clearly, in order for bundled payments to be effective in controlling cost for cervical spine surgery, proper risk stratification is necessary.…”

Section: Introductionmentioning

confidence: 99%

Low Socioeconomic Status Is Associated With Increased Complication Rates: Are Risk Adjustment Models Necessary in Cervical Spine Surgery?

Lieber

Boniello

Kerbel

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study.Objectives: The objective of this study was to determine whether lower socioeconomic status was associated with increased resource utilization following anterior discectomy and fusion (ACDF). Methods: The National Inpatient Sample database was queried for patients who underwent a primary, 1-to 2-level ACDF between 2005 and 2014. Trauma, malignancy, infection, and revision surgery were excluded. The top and bottom income quartiles were compared. Demographics, medical comorbidities, length of stay, complications, and hospital cost were compared between patients of top and bottom income quartiles. Results: A total of 69 844 cases were included. The bottom income quartile had a similar mean hospital stay (2.04 vs 1.77 days, P ¼ .412), more complications (2.45% vs 1.77%, P < .001), and a higher mortality rate (0.18% vs 0.11%, P ¼ .016). Multivariate analysis revealed bottom income quartile was an independent risk factor for complications (odds ratio ¼ 1.135, confidence interval ¼ 1.02-1.26). Interestingly, the bottom income quartile experienced lower mean hospital costs ($17 041 vs $17 958, P < .001).Conclusion: Patients in the lowest income group experienced more complications even after adjusting for comorbidities. Therefore, risk adjustment models, including socioeconomic status, may be necessary to avoid potential problems with access to orthopedic spine care for this patient population.

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Bundled payments in total joint arthroplasty and spine surgery

Cited by 84 publications

References 15 publications

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Low Socioeconomic Status Is Associated With Increased Complication Rates: Are Risk Adjustment Models Necessary in Cervical Spine Surgery?

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