Edwards Paul K, Mears Simon C, Barnes C Lowry
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Arthroplasty. 2017 Jun;32(6):1728-1731. doi: 10.1016/j.arth.2017.02.014. Epub 2017 Feb 28.
Alternative payment models are becoming increasingly more common with the rising cost of the US health care. Bundled payment programs for elective hip and knee arthroplasty have shown promising results by improved outcomes and significant cost reduction.
All consecutive total joint arthroplasty with diagnosis-related group (DRG) 469/470 were included in this study. And 1427 episodes from 2009 to 2012 were defined as the baseline group; 461 episodes from October 2013 to September 2014 were defined as the Bundled Payments for Care Improvement (BPCI) group.
BPCI group had a 14% reduction in cost per episode. The average length of stay decreased from 3.81 to 2.57 days. All-cause readmissions within 90 days of surgery decreased from 16% to 10%. The average cost of readmission decreased by 23%. Net Centers for Medicare and Medicaid Services (CMS) reconciliation payment for BPCI initiative participation was $1,012,962.79 for this 12-month study.
Our participation in the 2013-2014 CMS BPCI initiative for DRG 469/470 led to decreased readmissions and significant cost savings. In this study, minimizing hospital length of stay and discharging patients to home were the most effective strategies to achieve these outcomes.
随着美国医疗保健成本的不断上升，替代支付模式越来越普遍。选择性髋关节和膝关节置换术的捆绑支付计划通过改善治疗效果和显著降低成本显示出了有前景的结果。
本研究纳入了所有诊断相关组（DRG）为469/470的连续全关节置换术病例。2009年至2012年的1427例病例被定义为基线组；2013年10月至2014年9月的461例病例被定义为改善护理捆绑支付（BPCI）组。
BPCI组每例病例成本降低了14%。平均住院时间从3.81天降至2.57天。术后90天内的全因再入院率从16%降至10%。再入院的平均成本降低了23%。在这项为期12个月的研究中，医疗保险和医疗补助服务中心（CMS）因参与BPCI计划的净和解支付为1,012,962.79美元。
我们参与2013 - 2014年CMS针对DRG 469/470的BPCI计划导致再入院率降低和显著的成本节约。在本研究中，尽量缩短住院时间并让患者出院回家是实现这些结果的最有效策略。
