Sabeh Karim G, Rosas Samuel, Buller Leonard T, Roche Martin W, Hernandez Victor H
Department of Orthopaedics and Rehabilitation, University of Miami, Miami, Florida.
Department of Orthopedic Surgery, Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, Florida; Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
J Arthroplasty. 2017 Oct;32(10):2969-2973. doi: 10.1016/j.arth.2017.04.062. Epub 2017 May 11.
Total joint arthroplasty (TJA) accounts for more Medicare expenditure than any other inpatient procedure. The Comprehensive Care for Joint Replacement model was introduced to decrease cost and improve quality in TJA. The largest portion of episode-of-care costs occurs after discharge. This study sought to quantify the cost variation of primary total hip arthroplasty (THA) according to discharge disposition.
The Medicare and Humana claims databases were used to extract charges and reimbursements to compare day-of-surgery and 91-day postoperative costs simulating episode-of-care reimbursements. Of the patients who underwent primary THA, 257,120 were identified (204,912 from Medicare and 52,208 from Humana). Patients were stratified by discharge disposition: home with home health, skilled nursing facility, or inpatient rehabilitation facility.
There is a significant difference in the episode-of-care costs according to discharge disposition, with discharge to an inpatient rehabilitation facility the most costly and discharge to home the least costly.
Postdischarge costs represent a sizeable portion of the overall expense in THA, and optimizing patients to allow safe discharge to home may help reduce the cost of THA.
全关节置换术（TJA）在医疗保险支出中所占比例高于任何其他住院手术。为降低成本并提高TJA的质量，引入了关节置换综合护理模式。护理期间成本的最大部分发生在出院后。本研究旨在根据出院处置方式量化初次全髋关节置换术（THA）的成本差异。
利用医疗保险和Humana索赔数据库提取费用和报销数据，以比较手术当天和术后91天的成本，模拟护理期间的报销情况。在接受初次THA的患者中，共识别出257,120例（204,912例来自医疗保险，52,208例来自Humana）。患者按出院处置方式分层：居家并接受家庭健康护理、入住专业护理机构或住院康复机构。
根据出院处置方式，护理期间成本存在显著差异，出院后入住住院康复机构成本最高，出院回家成本最低。
出院后成本占THA总体费用的相当大一部分，优化患者情况以使其能够安全出院回家可能有助于降低THA的成本。
