Sibley Rachel A, Charubhumi Vanessa, Hutzler Lorraine H, Paoli Albit R, Bosco Joseph A
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
J Arthroplasty. 2017 May;32(5):1409-1413. doi: 10.1016/j.arth.2016.12.010. Epub 2016 Dec 21.
The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP). The objective of this study was to determine whether high-volume total joint hospitals perform better in these programs than their lower-volume counterparts.
We analyzed data from the New York Statewide Planning and Research Cooperative System database on total New York State hospital discharges from 2013 to 2015 for total knee and total hip arthroplasty. This was compared to data from Hospital Compare on HAC's, excess readmissions, and VBP. From these databases, we identified 123 hospitals in New York, which participated in all 3 Medicare pay-for-performance programs and performed total joint replacements.
Over the 3-year period spanning 2013-2015, hospitals in New York State performed an average of 1136.59 total joint replacement surgeries and achieved a mean readmission penalty of 0.005909. The correlation coefficient between surgery volume and combined performance score was 0.277. Of these correlations, surgery volume and VBP performance, and surgery volume and combined performance showed statistical significance (P < .01).
Our study demonstrates that there is a positive association between joint replacement volumes and overall hospital quality, as well as joint replacement volumes and VBP performance, specifically. These findings are consistent with previously reported associations between patient outcomes and procedure volumes. However, a relationship between joint replacement volume and HAC scores or readmission penalties could not be demonstrated.
医疗保险和医疗补助服务中心（CMS）正在将医疗保险从按服务收费计划转变为基于价值的绩效付费计划。为了实现这一目标，CMS启动了3个项目，试图定义质量，并寻求奖励表现出色的医院，惩罚表现不佳的医院。这些项目包括：（1）对医院获得性疾病（HAC）的处罚；（2）对某些疾病的超额再入院的处罚；（3）基于价值的采购（VBP）绩效。本研究的目的是确定高手术量的全关节置换医院在这些项目中的表现是否优于手术量较低的同行。
我们分析了纽约州全州规划和研究合作系统数据库中2013年至2015年纽约州全膝关节和全髋关节置换术的医院出院数据。将其与医院比较数据库中关于HAC、超额再入院和VBP的数据进行比较。从这些数据库中，我们确定了纽约州的123家医院，这些医院参与了所有3个医疗保险绩效付费项目，并进行了全关节置换手术。
在2013 - 2015年的3年期间，纽约州的医院平均进行了1136.59例全关节置换手术，平均再入院处罚为0.005909。手术量与综合绩效得分之间的相关系数为0.277。在这些相关性中，手术量与VBP绩效以及手术量与综合绩效具有统计学意义（P < .01）。
我们的研究表明，关节置换手术量与医院整体质量之间存在正相关，特别是关节置换手术量与VBP绩效之间。这些发现与先前报道的患者结局与手术量之间的关联一致。然而，未能证明关节置换手术量与HAC评分或再入院处罚之间存在关系。
