What Are the Economic Consequences of Unplanned Readmissions After TKA?

Abstract

If our results are generalizable, unplanned TKA readmissions lead to diminished total profit. Although associated with a positive contribution margin, this is likely to be a short-term phenomenon as the new CMS policy will result in readmissions coming at a steep cost to referral centers.

Surgeon Reimbursement Unchanged as Hospital Charges and Reimbursements Increase for Total Joint Arthroplasty

“…Williams et al [12] found that patients with extended LOS, defined as >4 days, and those with a greater number of comorbidities had higher readmission rates. Unplanned readmissions have been shown to decrease value and hospital profit by nearly 50% following both THA and TKA [13,14]. However, the present data demonstrate a significant inverse correlation for both THA and TKA between LOS and both CM and PM, suggesting that as LOS decreased, hospital charges and payments increased relative to the surgeon.…”

Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?

“…These new policies of the HRRP expose hospitals and ACOs to financial risk with penalties that range from 1% of 3% of their aggregate payments in a single year based on their excess 30-day readmissions. Researchers from a high-volume, urban tertiary orthopaedic center [9] recently estimated that their potential penalty from CMS could amount to over USD 6 million annually if their institution's all-cause risk-adjusted 30-day readmission rates exceeded the national mean. Healthcare bundle providers are exposed to the additional financial risk of accountability for the cost of readmissions during the bundle period (30 or 90 days) regardless of whether the readmission is causally related to the index surgery.…”

“…However, less is known about the financial impact of total joint readmissions. The scope of previous economic studies has been limited to a single institution [3,8,9,31,34]; a proprietary commercial database [26]; or the state of Michigan [6]. The recent release of the novel Nationwide Readmissions Database (NRD) by the Agency for Healthcare Research and Quality (AHRQ) for all age groups and payers prompted us to examine the economic burden of total joint readmissions from a national perspective.…”

Rates, causes, and types of readmissions after total joint arthroplasty

“…Among the reasons for this interest, it is possible to mention the following factors: the belief that readmissions are due to the lack of care quality. [2][3][4] and unplanned readmissions are undesirable and stressful situations for patients, physicians, and the health system [5,6] besides they are significant cost factors. [4,7,8] It is highly important to use readmission rates, while evaluating the quality and performance of hospitals.…”

“…[4,7,8] It is highly important to use readmission rates, while evaluating the quality and performance of hospitals. [3,9] Therefore, minimizing unnecessary readmissions decrease the health expenditures, while it provides a unique opportunity to servers and policymakers, since it enables health resources to be used more effectively and improves the care quality. [10] Readmission is a complex phenomenon which occurs with the common effect of several factors, not only a single factor.…”