Medicare reimbursement and orthopedic surgery: past, present, and future

Clement, R. Carter; Bhat, Suneel B.; Clement, Meredith E.; Krieg, James C.

doi:10.1007/s12178-017-9406-7

Cited by 48 publications

(30 citation statements)

References 16 publications

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“…35 The CJR is mandatory for all lower extremity joint arthroplasties in 67 geographical locations. 36 Notably, although the CJR risk adjusts for nonelective fractures, research suggests that compensations for complex patient populations are likely inadequate. 36–38 These higher-risk populations, as seen in the present analysis for dialysis patients, are far more likely to have an adverse event or readmission and therefore use more resources and costs for their treatment.…”

Section: Discussionmentioning

confidence: 99%

“…36 Notably, although the CJR risk adjusts for nonelective fractures, research suggests that compensations for complex patient populations are likely inadequate. 36–38 These higher-risk populations, as seen in the present analysis for dialysis patients, are far more likely to have an adverse event or readmission and therefore use more resources and costs for their treatment. As this risk factor is not modifiable through any known means, the result is that the patient's baseline health at the time of their presentation with an acute hip fracture has a tremendously negative impact, regardless of how well the surgery was performed.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, the CMS approved the Surgical Hip and Femur Fracture Treatment Program (SHFFT), which began July 2017. 36 However, the American Academy of Orthopaedic Surgeons has already expressed concern over inadequate risk adjustment and outcome measures. 36 The current study brings meaningful data to the discussion of risk-adjusted reimbursement for management of higher-risk patients, as dialysis dependence alone was found to be associated with over a two-fold risk of 30-day readmission and a nearly two-fold risk for AAE or a major adverse event.…”

Section: Discussionmentioning

confidence: 99%

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Dialysis Dependence Is Associated With Significantly Increased Odds of Perioperative Adverse Events After Geriatric Hip Fracture Surgery Even After Controlling for Demographic Factors and Comorbidities

et al. 2019

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Introduction:Previous studies evaluating the risk of perioperative adverse events after hip fracture surgery for dialysis-dependent patients are either institutional cohort studies or limited by patient numbers. The current study uses the National Surgical Quality Improvement Program database's large national patient population and 30-day follow-up window to address these weaknesses.Methods:National Surgical Quality Improvement Program databases (2006 to 2016) were queried for patients aged 60 years or older who underwent hip fracture surgery. Differences in 30-day outcomes based on preoperative dialysis dependence were compared using risk-adjusted logistic regression and coarsened exact matching for adverse events, need for revision surgery, readmission, and mortality. The proportion of adverse events that occurred before versus after discharge was also assessed.Results:A total of 288 dialysis-dependent and 16,392 non–dialysis-dependent patients met the inclusion criteria. Matched populations controlling for demographic factors (ie, age, sex, body mass index, and functional status) and overall health (American Society of Anesthesiologists class) found dialysis-dependent patients to be associated with significantly greater odds of any adverse event (odds ratio [OR] = 1.90), major adverse event (OR = 1.77), and unplanned readmission (OR = 2.48). Increased odds of minor adverse event (OR = 1.05), return to the operating room (OR = 1.66), and death (OR = 1.42) within 30 postoperative days were also found but were not statistically significant.Discussion:Even after controlling for demographics and health status, geriatric dialysis patients undergoing surgery for hip fracture are at significantly greater odds of adverse outcomes. Because of increased risks for geriatric dialysis patients undergoing surgery for hip fracture, surgical caution, patient counseling, and heightened surveillance must be observed throughout the perioperative period for this fragile population. Furthermore, hospitals and physicians must take the increased risks associated with dialysis into account when considering bundled payment reimbursement strategies and resource allocation for hip fracture care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dialysis Dependence Is Associated With Significantly Increased Odds of Perioperative Adverse Events After Geriatric Hip Fracture Surgery Even After Controlling for Demographic Factors and Comorbidities

et al. 2019

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“…The current CMS payment model utilizes Medical Severity (MS) Diagnosis Related Groups (DRG) to prospectively assign reimbursement to specific patients, regardless of what treatments are performed. 5 The DRG system is a departure from the fee-for-service model where reimbursement was proportional to the amount of services provided to each patient. 6 For the DRG system to be successful, reimbursement has to be appropriately risk-adjusted for health-care costs related to severity of patient comorbidities and injury characteristics.…”

Section: Introductionmentioning

confidence: 99%

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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“…Worldwide, today’s healthcare environment stresses the provision of high-quality care while reducing costs. In the United States (US), federal payments to healthcare providers have been tied to various activities: participation in improvement projects, quality metrics, and resource utilization through pay-for-performance programs such as the Merit-Based Incentive Payment System (MIPS) developed by the Center for Medicare and Medicaid Services (CMS) [ 1 ]. This growing trend is taking place in other industrialized countries that face the dilemma of rapidly rising healthcare costs [ 2 ] and is, in part, responsible for recent innovations in hospital-based care.…”

Section: Introductionmentioning

confidence: 99%

Designing the ideal perioperative pain management plan starts with multimodal analgesia

Schwenk

Mariano

2018

Korean J Anesthesiol

111

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Multimodal analgesia is defined as the use of more than one pharmacological class of analgesic medication targeting different receptors along the pain pathway with the goal of improving analgesia while reducing individual class-related side effects. Evidence today supports the routine use of multimodal analgesia in the perioperative period to eliminate the over-reliance on opioids for pain control and to reduce opioid-related adverse events. A multimodal analgesic protocol should be surgery-specific, functioning more like a checklist than a recipe, with options to tailor to the individual patient. Elements of this protocol may include opioids, non-opioid systemic analgesics like acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, and local anesthetics administered by infiltration, regional block, or the intravenous route. While implementation of multimodal analgesic protocols perioperatively is recommended as an intervention to decrease the prevalence of long-term opioid use following surgery, the concurrent crisis of drug shortages presents an additional challenge. Anesthesiologists and acute pain medicine specialists will need to advocate locally and nationally to ensure a steady supply of analgesic medications and in-class alternatives for their patients’ perioperative pain management.

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Medicare reimbursement and orthopedic surgery: past, present, and future

Cited by 48 publications

References 16 publications

Dialysis Dependence Is Associated With Significantly Increased Odds of Perioperative Adverse Events After Geriatric Hip Fracture Surgery Even After Controlling for Demographic Factors and Comorbidities

Dialysis Dependence Is Associated With Significantly Increased Odds of Perioperative Adverse Events After Geriatric Hip Fracture Surgery Even After Controlling for Demographic Factors and Comorbidities

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

Designing the ideal perioperative pain management plan starts with multimodal analgesia

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