Centers for Medicare &amp; Medicaid Services' Comprehensive Care for Joint Replacement: The Present and Future for Orthopedic Surgeons

Hogan, Craig; Sandoval, Melanie F.; Uhler, Lauren M.

doi:10.3928/01477447-20170302-03

Cited by 34 publications

(14 citation statements)

References 4 publications

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“…8 The cost model examined in this study follows the principles of the CCJR model which includes day-of-surgery costs along with all costs for 90 days post discharge, simulating an episode-ofcare model as put forth by the Center for Medicare and Medicaid Services. 11 Preoperative costs were excluded from this study. The episode of care included all payments made for a single primary TKA for the day of surgery and 90 days postoperatively.…”

Section: Methodsmentioning

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: Methodsmentioning

confidence: 99%

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

et al. 2018

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“…The rapidly increasing number of TKRs and their associated cost threaten to impose an enormous economic burden on the healthcare system in the United States and around the world. In an attempt to combat these rising costs, the Centers for Medicare and Medicaid Services (CMS) introduced the Comprehensive Care for Joint Replacement (CJR) Model in 2016, which proposes a bundled payment model [8]. Unlike fee-for-service payment models, bundled payments incentivize value-based care wherein providers use coordinated, multidisciplinary healthcare approaches to enhance quality, efficiency, and patient satisfaction while controlling costs [9].…”

Section: Introductionmentioning

confidence: 99%

A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Bell

Onyeukwu

Smith

et al. 2020

Sensors

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Rehabilitation has been shown to improve functional outcomes following total knee replacement (TKR). However, its delivery and associated costs are highly variable. The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study’s objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after TKR and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Specifically, we tested post-operative outpatient rehabilitation supplemented with interACTION (n = 13) by comparing it to a standard post-operative outpatient rehabilitation program (n = 12) using a randomized design. Attrition rates were relatively low and not significantly different between groups, indicating that participants found both interventions acceptable. A small (not statistically significant) decrease in the number of physical therapy visits was observed in the interACTION Group, therefore no significant difference in total cost could be observed. All patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial. Trial registration: ClinicalTrials.gov NCT02646761 “interACTION: A Portable Joint Function Monitoring and Training System for Remote Rehabilitation Following TKA” 6 January 2016.

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“…Our study demon-strates that the increased complication rates after THA in patients with hypothyroidism could translate into worse patient outcomes and increased cost of care. 29,30 Our study is not present without limitations. Being a database analysis study, the validity of our findings is reliant on the accuracy of procedural coding within the database.…”

Section: Discussionmentioning

confidence: 88%

Hypothyroidism Increases 90-Day Complications and Cost Following Primary Total Hip Arthroplasty

et al. 2019

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Hypothyroidism is common, and the incidence has been increasing annually in the United States. Abnormalities in thyroid hormone can have several effects on the endocrine, immune, and musculoskeletal systems of the body. The influence of hypothyroidism on outcomes following primary total hip arthroplasty (THA) is not well reported. The authors hypothesized that hypothyroidism was associated with a higher risk of postoperative complications and 90-day costs following primary THA. A retrospective review from 2005 to 2014 was performed using the Medicare Standard Analytical Files from the Pearl Diver database. Utilizing International Classification of Disease 9th revision (ICD-9) codes, the authors identified patients who underwent THA. Patients with a concurrent diagnosis of hypothyroidism were matched by age, gender, and Charlson's comorbidity index (CCI) to a control group. Ninety-day postoperative complications, readmission rates, complications related to implants, and cost of care were compared and assessed following primary THA between matched cohorts. Statistical analysis was performed using the programming language R (University of Auckland) to calculate odds ratios (OR) along with their respective 95% confidence intervals (95% CI), and p-values. A total of 383,898 patients underwent primary THA. Among them, 191,949 patients were diagnosed with hypothyroidism and 191,949 patients without hypothyroidism. Hypothyroidism was associated with greater odds of postoperative complications (p < 0.001), 90-day readmission rates (p < 0.001), implant related complications (p < 0.001), and total global 90-day episode of care cost (U.S. $17,549.96 vs. $16,645.01; p < 0.001). This study demonstrated an increased risk of postoperative complications (medical or implant related), increased readmission rates, and higher costs among patients with hypothyroidism following primary THA. Surgeons should counsel patients and determine strategies to medically optimize patients to mitigate risk and decrease cost.

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Centers for Medicare & Medicaid Services' Comprehensive Care for Joint Replacement: The Present and Future for Orthopedic Surgeons

Cited by 34 publications

References 4 publications

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

A Portable System for Remote Rehabilitation Following a Total Knee Replacement: A Pilot Randomized Controlled Clinical Study

Hypothyroidism Increases 90-Day Complications and Cost Following Primary Total Hip Arthroplasty

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