Should All Patients be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?
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...
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| Published in | The Journal of arthroplasty Vol. 31; no. 9; pp. 45 - 49 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
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United States
Elsevier Inc
01.09.2016
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| Abstract | 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. |
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| AbstractList | 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. BACKGROUNDAlternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care.METHODSWe prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions.RESULTSDuring 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 >5 points was associated with increased LOS and readmissions.CONCLUSIONPatients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care. We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions. 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 >5 points was associated with increased LOS and readmissions. Patients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. |
| Author | Dattilo, Jonathan R., MD Rozell, Joshua C., MD Lee, Gwo Chin, MD Courtney, P. Maxwell, MD Wu, Chia H., MD, MBA |
| Author_xml | – sequence: 1 fullname: Rozell, Joshua C., MD – sequence: 2 fullname: Courtney, P. Maxwell, MD – sequence: 3 fullname: Dattilo, Jonathan R., MD – sequence: 4 fullname: Wu, Chia H., MD, MBA – sequence: 5 fullname: Lee, Gwo Chin, MD |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27118348$$D View this record in MEDLINE/PubMed |
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| Keywords | total joint arthroplasty comorbidity alternative payment model readmission bundled payment |
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| Snippet | Abstract Background Alternative payment models (APM) in total joint replacement incentivize cost effective healthcare delivery and reward reductions in length... Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS),... BACKGROUNDAlternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS),... |
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| SubjectTerms | 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 |
| Title | Should All Patients be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty? |
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