Should All Patients be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?

• Published in: The Journal of arthroplasty Vol. 31; no. 9; pp. 45 - 49
• Main Authors: Rozell, Joshua C., MD, Courtney, P. Maxwell, MD, Dattilo, Jonathan R., MD, Wu, Chia H., MD, MBA, Lee, Gwo Chin, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Adult; Aged; Aged, 80 and over; alternative payment model; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; bundled payment; Comorbidity; Female; Health Expenditures; Health Services Accessibility; Humans; Length of Stay; Male; Middle Aged; Orthopedics; Patient Readmission; Patient Selection; Prospective Studies; readmission; Reimbursement Mechanisms; Risk Factors; total joint arthroplasty; Young Adult; total joint arthroplasty; comorbidity; alternative payment model; readmission; bundled payment
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.03.020

Abstract Background Alternative payment models (APM) in total joint replacement incentivize cost effective healthcare delivery and reward reductions in length of stay (LOS), complications and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to healthcare. Methods We prospectively evaluated 802 consecutive primary THA and TKA patients evaluating comorbidities associated with increased LOS and readmissions. Results During this 9-month period, 115 patients (14.3%) required hospitalization >3 days and 16 (1.99%) were readmitted within 90 days. Univariate analysis demonstrated that preoperative narcotic use, heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and liver disease were more likely to require hospitalization >3 days. In multivariate analysis, CKD and COPD were independent risk factors for LOS >3 days. A Charlson Comorbidity Index (CCI) >5 points was associated with increased LOS and readmissions. Conclusions Patients with CKD, COPD, and CCI >5 points should not be included in APM for THA and TKA.