Sibia Udai S, Turcotte Justin J, MacDonald James H, King Paul J
Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, Maryland.
Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland.
J Arthroplasty. 2017 Sep;32(9):2655-2657. doi: 10.1016/j.arth.2017.03.058. Epub 2017 Apr 5.
The 72-hour Medicare mandate (3-night stay rule) requires a 3-day inpatient stay for patients discharging to skilled nursing facilities (SNFs). Studies show that 48%-64% of Medicare total joint arthroplasty (TJA) patients are safe for discharge to SNFs on postoperative day (POD) #2. The purpose of this study was to extrapolate the financial impact of the 3-night stay rule.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all primary TJAs performed in 2015. Discharge destination was recorded. Institutional cost accounting examined costs for patients discharging on POD #2 vs POD #3.
A total of 42,423 TJAs (14,395 total hip arthroplasties [THAs] and 28,028 total knee arthroplasties [TKAs]) were performed in patients over the age of 65 years. Of these patients, 5252 THAs (36.5%) and 12,022 TKAs (42.9%) were discharged from the hospital on POD #3, with 2404 THAs (16.7%) and 5083 TKAs (18.1%) being discharged to SNFs. Institutional cost accounting revealed hospital costs for THA were $2014 more, whereas hospital costs for TKA were $1814 more for a 3-day length of stay when compared with a 2-day length of stay (P < .001). The mean charge per day for an SNF was $486.
The National Surgical Quality Improvement Program database is a representative sample of all surgeries performed in the United States. Extrapolating our findings to all Medicare TJAs nationally gives an estimated $63 million in annual savings. Medicare mandated, but potentially medically unnecessary inpatient days at a higher level of care increase the total cost for TJAs. Policies regarding minimum stay requirements before discharge should be re-evaluated.
医疗保险72小时强制规定（3晚住院规则）要求出院至专业护理机构（SNF）的患者住院3天。研究表明，48%-64%的医疗保险全关节置换术（TJA）患者在术后第2天出院至SNF是安全的。本研究的目的是推断3晚住院规则的财务影响。
查询美国外科医师学会国家外科质量改进计划数据库中2015年进行的所有初次TJA。记录出院目的地。机构成本核算检查了术后第2天出院与术后第3天出院患者的费用。
65岁以上患者共进行了42423例TJA（14395例全髋关节置换术[THA]和28028例全膝关节置换术[TKA]）。在这些患者中，5252例THA（36.5%）和12022例TKA（42.9%）在术后第3天出院，2404例THA（16.7%）和5083例TKA（18.1%）出院至SNF。机构成本核算显示，与住院2天相比，THA住院3天的医院成本多2014美元，TKA住院3天的医院成本多1814美元（P<.001）。SNF的日均费用为486美元。
国家外科质量改进计划数据库是美国所有手术的代表性样本。将我们的研究结果推广到全国所有医疗保险TJA患者，估计每年可节省6300万美元。医疗保险规定的，但可能在医疗上不必要的更高护理水平的住院天数增加了TJA的总成本。应重新评估出院前最低住院要求的政策。
