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No Changes in Patient Selection and Value-Based Metrics for Total Hip Arthroplasty After Comprehensive Care for Joint Replacement Bundle Implementation at a Single Center.

Publication ,  Journal Article
Plate, JF; Ryan, SP; Black, CS; Howell, CB; Jiranek, WA; Bolognesi, MP; Seyler, TM
Published in: The Journal of arthroplasty
August 2019

Alternative payment models for total hip arthroplasty (THA) were initiated by the Center for Medicare and Medicaid Services to decrease overall healthcare cost. The associated shift of financial risk to participating institutions may negatively influence patient selection to avoid high cost of care ("cherry picking," "lemon dropping"). This study evaluated the impact of the Comprehensive Care for Joint Replacement (CJR) model on patient selection, care delivery, and hospital costs at a single care center.Patients undergoing a primary THA from 2015-2017 were stratified by insurance type (Medicare and commercial insurance) and whether care was provided before (pre-CJR) or after (post-CJR) CJR bundle implementation. Patient age, gender, and body mass index, Elixhauser comorbidities and American Society of Anesthesiologists scores, were analyzed. Delivery of care variables including surgery duration, discharge disposition, length of stay, and direct hospital costs were compared pre- and post-CJR.A total of 751 THA patients (273 Medicare and 478 commercial Insurance) were evaluated pre-CJR (29%) and post-CJR (71%). Patient demographics were similar (age, gender, BMI); however, commercially insured patients had less comorbidities pre-CJR (P = .033). Medicare patient post-CJR length of stay (P = .010) was reduced with a trend toward discharge to home (P = .019). Surgical time, operating room service time, 90-day readmissions and direct hospital costs were similar pre- and post-CJR.There was no differential patient selection after CJR bundle implementation and value-based metrics (surgical time, operating room service time) were not affected. Patients were discharged sooner and more often to home. However, overall direct hospital expenses remained unchanged revealing that any cost savings were for insurance providers, not participating hospitals.

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Published In

The Journal of arthroplasty

DOI

EISSN

1532-8406

ISSN

0883-5403

Publication Date

August 2019

Volume

34

Issue

8

Start / End Page

1581 / 1584

Related Subject Headings

  • United States
  • Patient Selection
  • Patient Discharge
  • Patient Care Bundles
  • Orthopedics
  • Operative Time
  • Middle Aged
  • Medicare
  • Male
  • Length of Stay
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Plate, J. F., Ryan, S. P., Black, C. S., Howell, C. B., Jiranek, W. A., Bolognesi, M. P., & Seyler, T. M. (2019). No Changes in Patient Selection and Value-Based Metrics for Total Hip Arthroplasty After Comprehensive Care for Joint Replacement Bundle Implementation at a Single Center. The Journal of Arthroplasty, 34(8), 1581–1584. https://doi.org/10.1016/j.arth.2019.05.016
Plate, Johannes F., Sean P. Ryan, Collin S. Black, Claire B. Howell, William A. Jiranek, Michael P. Bolognesi, and Thorsten M. Seyler. “No Changes in Patient Selection and Value-Based Metrics for Total Hip Arthroplasty After Comprehensive Care for Joint Replacement Bundle Implementation at a Single Center.The Journal of Arthroplasty 34, no. 8 (August 2019): 1581–84. https://doi.org/10.1016/j.arth.2019.05.016.
Plate JF, Ryan SP, Black CS, Howell CB, Jiranek WA, Bolognesi MP, et al. No Changes in Patient Selection and Value-Based Metrics for Total Hip Arthroplasty After Comprehensive Care for Joint Replacement Bundle Implementation at a Single Center. The Journal of arthroplasty. 2019 Aug;34(8):1581–4.
Plate, Johannes F., et al. “No Changes in Patient Selection and Value-Based Metrics for Total Hip Arthroplasty After Comprehensive Care for Joint Replacement Bundle Implementation at a Single Center.The Journal of Arthroplasty, vol. 34, no. 8, Aug. 2019, pp. 1581–84. Epmc, doi:10.1016/j.arth.2019.05.016.
Plate JF, Ryan SP, Black CS, Howell CB, Jiranek WA, Bolognesi MP, Seyler TM. No Changes in Patient Selection and Value-Based Metrics for Total Hip Arthroplasty After Comprehensive Care for Joint Replacement Bundle Implementation at a Single Center. The Journal of arthroplasty. 2019 Aug;34(8):1581–1584.
Journal cover image

Published In

The Journal of arthroplasty

DOI

EISSN

1532-8406

ISSN

0883-5403

Publication Date

August 2019

Volume

34

Issue

8

Start / End Page

1581 / 1584

Related Subject Headings

  • United States
  • Patient Selection
  • Patient Discharge
  • Patient Care Bundles
  • Orthopedics
  • Operative Time
  • Middle Aged
  • Medicare
  • Male
  • Length of Stay