Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster?
As the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus re...
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Published in | The Journal of arthroplasty Vol. 36; no. 3; pp. 833 - 836 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.03.2021
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Abstract | As the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.
A retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution’s average payment for Medicare readmissions and observations, actual and potential savings were calculated.
Sixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status.
At our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%. |
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AbstractList | As the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.
A retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution’s average payment for Medicare readmissions and observations, actual and potential savings were calculated.
Sixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status.
At our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%. BACKGROUNDAs the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department. METHODSA retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution's average payment for Medicare readmissions and observations, actual and potential savings were calculated. RESULTSSixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status. CONCLUSIONAt our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%. |
Author | Schwarzkopf, Ran Hutzler, Lorraine H. Lygrisse, Katherine A. Rozell, Joshua C. Zak, Stephen Singh, Vivek |
Author_xml | – sequence: 1 givenname: Katherine A. orcidid: 0000-0001-6678-4192 surname: Lygrisse fullname: Lygrisse, Katherine A. – sequence: 2 givenname: Stephen surname: Zak fullname: Zak, Stephen – sequence: 3 givenname: Vivek orcidid: 0000-0003-2450-1785 surname: Singh fullname: Singh, Vivek – sequence: 4 givenname: Lorraine H. surname: Hutzler fullname: Hutzler, Lorraine H. – sequence: 5 givenname: Ran surname: Schwarzkopf fullname: Schwarzkopf, Ran – sequence: 6 givenname: Joshua C. surname: Rozell fullname: Rozell, Joshua C. |
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CitedBy_id | crossref_primary_10_1302_2633_1462_37_BJO_2022_0026_R1 crossref_primary_10_1016_j_arth_2022_02_031 crossref_primary_10_1007_s00402_022_04618_8 crossref_primary_10_1016_j_arth_2022_02_017 |
Cites_doi | 10.1377/hlthaff.2013.0662 10.1056/NEJMsa1513024 10.1097/00005650-199804000-00015 10.1016/j.arth.2016.02.029 10.1016/S0196-0644(97)70316-0 10.1016/j.ajem.2004.03.009 10.1097/HMR.0b013e3181f3c035 10.1111/j.1553-2712.2008.00082.x 10.1371/journal.pone.0024326 10.1111/j.1553-2712.2011.01151.x 10.5435/JAAOS-D-17-00022 10.1377/hlthaff.2011.0926 10.1111/j.1527-5299.2005.03844.x 10.2106/JBJS.N.01196 10.1001/jama.2016.12330 10.1056/NEJMsa0803563 10.1056/NEJM199812243392603 10.1377/hlthaff.2012.0323 10.1007/s11999-017-5244-6 10.1016/j.arth.2016.04.010 10.1111/j.1553-2712.1999.tb00152.x 10.1097/MLR.0000000000000601 10.1016/j.arth.2018.05.015 10.1136/bmj.37956.664236.EE |
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Keywords | bundle payment emergency department readmission total joint observation |
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References | Mahajan, Mahajan, Nguyen, Bui, Abbott, Osborne (bib11) 2020; 22 Rydman, Isola, Roberts, Zalenski, Mcdermott, Murphy (bib26) 1998; 36 Kurtz, Lau, Ong, Adler, Kolisek, Manley (bib7) 2017; 475 Jencks, Williams, Coleman (bib9) 2009; 360 Venkatesh, Geisler, Chambers, Baugh, Bohan, Schuur (bib19) 2011; 6 Rydman, Roberts, Albrecht, Zalenski, McDermott (bib25) 1999; 6 Altman (bib2) 2012; 31 Bosco, Harty, Iorio (bib10) 2018; 26 Boraiah, Inneh, Rathod, Band, Bosco, Iorio (bib13) 2014; 97 Zuckerman, Sheingold, Orav, Ruhter, Epstein (bib5) 2016; 374 Baugh, Venkatesh, Bohan (bib18) 2011; 36 Gold, Slover, Joo, Bosco, Iorio, Oh (bib12) 2016; 31 (bib14) 2009 Farkouh, Smars, Reeder, Zinsmeister, Evans, Meloy (bib23) 1998; 339 Wiler, Ross, Ginde (bib17) 2011; 18 Rydman, Zalenski, Roberts, Albrecht, Misiewicz, Kampe (bib24) 1997; 29 Storrow, Collins, Lyons, Wagoner, Gibler, Lindsell (bib30) 2005; 11 Baugh, Venkatesh, Hilton, Samuel, Schuur, Bohan (bib15) 2012; 31 Ross, Hockenberry, Mutter, Barrett, Wheatley, Pitts (bib16) 2013; 32 bib21 Luzzi, Fleischman, Matthews, Crizer, Wilsman, Parvizi (bib8) 2018; 33 bib22 Jagminas, Partridge (bib27) 2005; 23 Clair, Evangelista, Lajam, Slover, Bosco, Iorio (bib6) 2016; 31 Goodacre, Nicholl, Dixon, Cross, Angelini, Arnold (bib29) 2004; 328 Venkatesh, Wang, Ross, Altaf, Suter, Vellanky (bib20) 2016; 54 Ibrahim, Kim, McConnell (bib1) 2016; 316 bib3 bib4 Baugh, Stephen Bohan (bib28) 2008; 15 Boraiah (10.1016/j.arth.2020.09.021_bib13) 2014; 97 Bosco (10.1016/j.arth.2020.09.021_bib10) 2018; 26 Rydman (10.1016/j.arth.2020.09.021_bib26) 1998; 36 Clair (10.1016/j.arth.2020.09.021_bib6) 2016; 31 Venkatesh (10.1016/j.arth.2020.09.021_bib19) 2011; 6 Ibrahim (10.1016/j.arth.2020.09.021_bib1) 2016; 316 (10.1016/j.arth.2020.09.021_bib14) 2009 Ross (10.1016/j.arth.2020.09.021_bib16) 2013; 32 Rydman (10.1016/j.arth.2020.09.021_bib25) 1999; 6 Storrow (10.1016/j.arth.2020.09.021_bib30) 2005; 11 Baugh (10.1016/j.arth.2020.09.021_bib18) 2011; 36 Mahajan (10.1016/j.arth.2020.09.021_bib11) 2020; 22 Jencks (10.1016/j.arth.2020.09.021_bib9) 2009; 360 Farkouh (10.1016/j.arth.2020.09.021_bib23) 1998; 339 Kurtz (10.1016/j.arth.2020.09.021_bib7) 2017; 475 Gold (10.1016/j.arth.2020.09.021_bib12) 2016; 31 Altman (10.1016/j.arth.2020.09.021_bib2) 2012; 31 Wiler (10.1016/j.arth.2020.09.021_bib17) 2011; 18 Baugh (10.1016/j.arth.2020.09.021_bib15) 2012; 31 Jagminas (10.1016/j.arth.2020.09.021_bib27) 2005; 23 Zuckerman (10.1016/j.arth.2020.09.021_bib5) 2016; 374 Venkatesh (10.1016/j.arth.2020.09.021_bib20) 2016; 54 Goodacre (10.1016/j.arth.2020.09.021_bib29) 2004; 328 Luzzi (10.1016/j.arth.2020.09.021_bib8) 2018; 33 Baugh (10.1016/j.arth.2020.09.021_bib28) 2008; 15 Rydman (10.1016/j.arth.2020.09.021_bib24) 1997; 29 |
References_xml | – year: 2009 ident: bib14 article-title: Medicare Benefit Policy Manual Chapter 6-Hospital Services Covered Under Part B – volume: 31 start-page: 2314 year: 2012 end-page: 2323 ident: bib15 article-title: Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year publication-title: Health Aff contributor: fullname: Bohan – volume: 328 start-page: 254 year: 2004 end-page: 257 ident: bib29 article-title: Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care publication-title: Br Med J contributor: fullname: Arnold – ident: bib4 article-title: Comprehensive Care for Joint Replacement Model | CMS Innovation Center n.d. – volume: 6 start-page: 178 year: 1999 end-page: 183 ident: bib25 article-title: Patient satisfaction with an emergency department asthma observation unit publication-title: Acad Emerg Med contributor: fullname: McDermott – volume: 15 start-page: 445 year: 2008 end-page: 452 ident: bib28 article-title: Estimating observation unit profitability with options modeling publication-title: Acad Emerg Med contributor: fullname: Stephen Bohan – volume: 339 start-page: 1882 year: 1998 end-page: 1888 ident: bib23 article-title: A clinical trial of a chest-pain observation unit for patients with unstable angina publication-title: N Engl J Med contributor: fullname: Meloy – volume: 475 start-page: 2926 year: 2017 end-page: 2937 ident: bib7 article-title: Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty? publication-title: Clin Orthop Relat Res contributor: fullname: Manley – ident: bib21 article-title: Hospital Readmissions Reduction Program (HRRP) | CMS n.d. – volume: 31 start-page: 1923 year: 2012 end-page: 1930 ident: bib2 article-title: The lessons of medicare’s prospective payment system show that the bundled payment program faces challenges publication-title: Health Aff contributor: fullname: Altman – volume: 23 start-page: 111 year: 2005 end-page: 113 ident: bib27 article-title: A comparison of emergency department versus inhospital chest pain observation units publication-title: Am J Emerg Med contributor: fullname: Partridge – ident: bib3 article-title: Bundled Payments for Care Improvement (BPCI) Initiative: General Information | CMS Innovation Center n.d. – volume: 22 start-page: 73 year: 2020 end-page: 85 ident: bib11 article-title: Predictive models for identifying risk of readmission after index hospitalization for hip arthroplasty: a systematic review publication-title: J Orthop contributor: fullname: Osborne – volume: 97 start-page: 1921 year: 2014 end-page: 1928 ident: bib13 article-title: Management of modifiable risk factors prior to primary hip and knee arthroplasty: a readmission risk assessment tool publication-title: J Bone Joint Surg Am contributor: fullname: Iorio – volume: 33 start-page: 2734 year: 2018 end-page: 2739 ident: bib8 article-title: The “bundle busters”: incidence and costs of postacute complications following total joint arthroplasty publication-title: J Arthroplasty contributor: fullname: Parvizi – volume: 6 year: 2011 ident: bib19 article-title: Use of observation care in US emergency departments, 2001 to 2008 publication-title: PLoS One contributor: fullname: Schuur – volume: 11 start-page: 68 year: 2005 end-page: 72 ident: bib30 article-title: Emergency department observation of heart failure: preliminary analysis of safety and cost publication-title: Congest Heart Fail contributor: fullname: Lindsell – volume: 26 start-page: 817 year: 2018 end-page: 822 ident: bib10 article-title: Bundled payment arrangements publication-title: J Am Acad Orthop Surg contributor: fullname: Iorio – volume: 29 start-page: 109 year: 1997 end-page: 115 ident: bib24 article-title: Patient satisfaction with an emergency department chest pain observation unit publication-title: Ann Emerg Med contributor: fullname: Kampe – volume: 360 start-page: 1418 year: 2009 end-page: 1428 ident: bib9 article-title: Rehospitalizations among patients in the medicare fee-for-service program publication-title: N Engl J Med contributor: fullname: Coleman – volume: 54 start-page: 1070 year: 2016 end-page: 1077 ident: bib20 article-title: Hospital use of observation stays: cross-sectional study of the impact on readmission rates publication-title: Med Care contributor: fullname: Vellanky – volume: 374 start-page: 1543 year: 2016 end-page: 1551 ident: bib5 article-title: Readmissions, observation, and the hospital readmissions reduction program publication-title: N Engl J Med contributor: fullname: Epstein – volume: 31 start-page: 1862 year: 2016 end-page: 1865 ident: bib6 article-title: Cost analysis of total joint arthroplasty readmissions in a bundled payment care improvement initiative publication-title: J Arthroplasty contributor: fullname: Iorio – volume: 36 start-page: 28 year: 2011 end-page: 37 ident: bib18 article-title: Emergency department observation units: a clinical and financial benefit for hospitals publication-title: Health Care Manage Rev contributor: fullname: Bohan – volume: 32 start-page: 2149 year: 2013 end-page: 2156 ident: bib16 article-title: Protocol-driven emergency department observation units offer savings, shorter stays, and reduced admissions publication-title: Health Aff contributor: fullname: Pitts – volume: 18 start-page: 959 year: 2011 end-page: 965 ident: bib17 article-title: National study of emergency department observation services publication-title: Acad Emerg Med contributor: fullname: Ginde – ident: bib22 article-title: Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial - PubMed n.d – volume: 31 start-page: 2385 year: 2016 end-page: 2388 ident: bib12 article-title: Association of depression with 90-day hospital readmission after total joint arthroplasty publication-title: J Arthroplasty contributor: fullname: Oh – volume: 316 start-page: 1258 year: 2016 end-page: 1259 ident: bib1 article-title: The CMS comprehensive care model and racial disparity in joint replacement publication-title: JAMA contributor: fullname: McConnell – volume: 36 start-page: 599 year: 1998 end-page: 609 ident: bib26 article-title: Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population a randomized trial of Health status outcome and cost publication-title: Med Care contributor: fullname: Murphy – volume: 32 start-page: 2149 year: 2013 ident: 10.1016/j.arth.2020.09.021_bib16 article-title: Protocol-driven emergency department observation units offer savings, shorter stays, and reduced admissions publication-title: Health Aff doi: 10.1377/hlthaff.2013.0662 contributor: fullname: Ross – volume: 374 start-page: 1543 year: 2016 ident: 10.1016/j.arth.2020.09.021_bib5 article-title: Readmissions, observation, and the hospital readmissions reduction program publication-title: N Engl J Med doi: 10.1056/NEJMsa1513024 contributor: fullname: Zuckerman – year: 2009 ident: 10.1016/j.arth.2020.09.021_bib14 – volume: 36 start-page: 599 year: 1998 ident: 10.1016/j.arth.2020.09.021_bib26 article-title: Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population a randomized trial of Health status outcome and cost publication-title: Med Care doi: 10.1097/00005650-199804000-00015 contributor: fullname: Rydman – volume: 31 start-page: 1862 year: 2016 ident: 10.1016/j.arth.2020.09.021_bib6 article-title: Cost analysis of total joint arthroplasty readmissions in a bundled payment care improvement initiative publication-title: J Arthroplasty doi: 10.1016/j.arth.2016.02.029 contributor: fullname: Clair – volume: 29 start-page: 109 year: 1997 ident: 10.1016/j.arth.2020.09.021_bib24 article-title: Patient satisfaction with an emergency department chest pain observation unit publication-title: Ann Emerg Med doi: 10.1016/S0196-0644(97)70316-0 contributor: fullname: Rydman – volume: 23 start-page: 111 year: 2005 ident: 10.1016/j.arth.2020.09.021_bib27 article-title: A comparison of emergency department versus inhospital chest pain observation units publication-title: Am J Emerg Med doi: 10.1016/j.ajem.2004.03.009 contributor: fullname: Jagminas – volume: 36 start-page: 28 year: 2011 ident: 10.1016/j.arth.2020.09.021_bib18 article-title: Emergency department observation units: a clinical and financial benefit for hospitals publication-title: Health Care Manage Rev doi: 10.1097/HMR.0b013e3181f3c035 contributor: fullname: Baugh – volume: 15 start-page: 445 year: 2008 ident: 10.1016/j.arth.2020.09.021_bib28 article-title: Estimating observation unit profitability with options modeling publication-title: Acad Emerg Med doi: 10.1111/j.1553-2712.2008.00082.x contributor: fullname: Baugh – volume: 6 year: 2011 ident: 10.1016/j.arth.2020.09.021_bib19 article-title: Use of observation care in US emergency departments, 2001 to 2008 publication-title: PLoS One doi: 10.1371/journal.pone.0024326 contributor: fullname: Venkatesh – volume: 18 start-page: 959 year: 2011 ident: 10.1016/j.arth.2020.09.021_bib17 article-title: National study of emergency department observation services publication-title: Acad Emerg Med doi: 10.1111/j.1553-2712.2011.01151.x contributor: fullname: Wiler – volume: 26 start-page: 817 year: 2018 ident: 10.1016/j.arth.2020.09.021_bib10 article-title: Bundled payment arrangements publication-title: J Am Acad Orthop Surg doi: 10.5435/JAAOS-D-17-00022 contributor: fullname: Bosco – volume: 31 start-page: 2314 year: 2012 ident: 10.1016/j.arth.2020.09.021_bib15 article-title: Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year publication-title: Health Aff doi: 10.1377/hlthaff.2011.0926 contributor: fullname: Baugh – volume: 11 start-page: 68 year: 2005 ident: 10.1016/j.arth.2020.09.021_bib30 article-title: Emergency department observation of heart failure: preliminary analysis of safety and cost publication-title: Congest Heart Fail doi: 10.1111/j.1527-5299.2005.03844.x contributor: fullname: Storrow – volume: 97 start-page: 1921 year: 2014 ident: 10.1016/j.arth.2020.09.021_bib13 article-title: Management of modifiable risk factors prior to primary hip and knee arthroplasty: a readmission risk assessment tool publication-title: J Bone Joint Surg Am doi: 10.2106/JBJS.N.01196 contributor: fullname: Boraiah – volume: 316 start-page: 1258 year: 2016 ident: 10.1016/j.arth.2020.09.021_bib1 article-title: The CMS comprehensive care model and racial disparity in joint replacement publication-title: JAMA doi: 10.1001/jama.2016.12330 contributor: fullname: Ibrahim – volume: 360 start-page: 1418 year: 2009 ident: 10.1016/j.arth.2020.09.021_bib9 article-title: Rehospitalizations among patients in the medicare fee-for-service program publication-title: N Engl J Med doi: 10.1056/NEJMsa0803563 contributor: fullname: Jencks – volume: 339 start-page: 1882 year: 1998 ident: 10.1016/j.arth.2020.09.021_bib23 article-title: A clinical trial of a chest-pain observation unit for patients with unstable angina publication-title: N Engl J Med doi: 10.1056/NEJM199812243392603 contributor: fullname: Farkouh – volume: 31 start-page: 1923 year: 2012 ident: 10.1016/j.arth.2020.09.021_bib2 article-title: The lessons of medicare’s prospective payment system show that the bundled payment program faces challenges publication-title: Health Aff doi: 10.1377/hlthaff.2012.0323 contributor: fullname: Altman – volume: 475 start-page: 2926 year: 2017 ident: 10.1016/j.arth.2020.09.021_bib7 article-title: Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty? publication-title: Clin Orthop Relat Res doi: 10.1007/s11999-017-5244-6 contributor: fullname: Kurtz – volume: 31 start-page: 2385 year: 2016 ident: 10.1016/j.arth.2020.09.021_bib12 article-title: Association of depression with 90-day hospital readmission after total joint arthroplasty publication-title: J Arthroplasty doi: 10.1016/j.arth.2016.04.010 contributor: fullname: Gold – volume: 6 start-page: 178 year: 1999 ident: 10.1016/j.arth.2020.09.021_bib25 article-title: Patient satisfaction with an emergency department asthma observation unit publication-title: Acad Emerg Med doi: 10.1111/j.1553-2712.1999.tb00152.x contributor: fullname: Rydman – volume: 54 start-page: 1070 year: 2016 ident: 10.1016/j.arth.2020.09.021_bib20 article-title: Hospital use of observation stays: cross-sectional study of the impact on readmission rates publication-title: Med Care doi: 10.1097/MLR.0000000000000601 contributor: fullname: Venkatesh – volume: 22 start-page: 73 year: 2020 ident: 10.1016/j.arth.2020.09.021_bib11 article-title: Predictive models for identifying risk of readmission after index hospitalization for hip arthroplasty: a systematic review publication-title: J Orthop contributor: fullname: Mahajan – volume: 33 start-page: 2734 year: 2018 ident: 10.1016/j.arth.2020.09.021_bib8 article-title: The “bundle busters”: incidence and costs of postacute complications following total joint arthroplasty publication-title: J Arthroplasty doi: 10.1016/j.arth.2018.05.015 contributor: fullname: Luzzi – volume: 328 start-page: 254 year: 2004 ident: 10.1016/j.arth.2020.09.021_bib29 article-title: Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care publication-title: Br Med J doi: 10.1136/bmj.37956.664236.EE contributor: fullname: Goodacre |
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Snippet | As the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors... BACKGROUNDAs the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce... |
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SubjectTerms | Aged Arthroplasty, Replacement, Hip Arthroplasty, Replacement, Knee bundle payment emergency department Emergency Service, Hospital Humans Medicare observation Patient Care Bundles Patient Readmission readmission Retrospective Studies Risk Factors total joint United States |
Title | Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster? |
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