Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2019 May;34(5):819-823. doi: 10.1016/j.arth.2019.01.029. Epub 2019 Jan 23.
As alternative payment models increase in popularity for total joint arthroplasty (TJA), providers and hospitals now share the financial risk associated with unexpected readmissions. While studies have identified postacute care as a driver for costs in a bundle, the fiscal burden associated with specific causes of readmission is unclear. The purpose of this study is to quantify the additional costs associated with each of the causes of readmission following primary TJA.
We reviewed a consecutive series of primary TJA patients at our institution from 2015 to 2016 using claims data from the Centers for Medicare and Medicaid Services and Medicare Advantage patients from a single private insurer. We collected demographic data, medical comorbidities, 90-day episode-of-care costs, and readmissions for all patients. Medical records for each readmission were reviewed and classified into 1 of 11 categories. We then compared the mean facility readmission costs, postacute care costs, and overall 90-day episode-of-care costs between the reasons for readmission.
Of the 4704 patients, there were 325 readmissions in 286 patients (6.1%), with 50% being readmitted to a different facility than their index surgery hospital. The mean additional cost was $8588 per readmission. Medical reasons accounted for the majority of readmissions (n = 257, 79.1%). However, patients readmitted for revision surgery (n = 68, 20.9%) had the highest mean readmission cost ($15,356, P < .001). Furthermore, readmissions for revision surgery had the highest mean postacute care ($37,207, P = .002) and overall episode-of-care costs ($52,162, P = .003). Risk factors for readmission included age >75 years (odds ratio [OR], 1.85; P < .001), body mass index >35 kg/m (OR, 1.63; P = .004), history of congestive heart failure (OR, 2.47; P = .002), diabetes mellitus (OR, 2.0; P < .001), and renal disease (OR, 2.28; P = .005).
Providers participating in alternative payment models should be cognizant of the increased bundle costs attributed to readmissions, especially due to revision surgery. Improved communication with patients and close postoperative monitoring may help minimize the large percentage of readmissions at different facilities.
随着全关节置换术（TJA）替代支付模式的日益普及，提供者和医院现在共同承担与意外再入院相关的财务风险。虽然研究已经确定了急性后护理是捆绑费用的驱动因素，但再入院具体原因所带来的财政负担尚不清楚。本研究的目的是量化 TJA 后主要原因导致的再入院相关的额外成本。
我们使用医疗保险和医疗补助服务中心的索赔数据和单一私人保险公司的医疗保险优势患者，对我院 2015 年至 2016 年连续系列的原发性 TJA 患者进行了回顾性研究。我们收集了所有患者的人口统计学数据、合并症、90 天治疗期的费用和再入院情况。对每位再入院患者的病历进行了审查，并分为 11 个类别之一。然后，我们比较了再入院原因之间的平均医疗机构再入院费用、急性后护理费用和整体 90 天治疗期费用。
在 4704 名患者中，有 286 名患者（6.1%）发生了 325 次再入院，其中 50%的患者再入院的医院与指数手术医院不同。每次再入院的平均额外费用为 8588 美元。医疗原因是再入院的主要原因（n=257，79.1%）。然而，因翻修手术而再次入院的患者（n=68，20.9%）的再入院平均费用最高（$15356，P<.001）。此外，翻修手术导致的再入院的平均急性后护理（$37207，P=.002）和整体治疗期费用（$52162，P=.003）最高。再入院的风险因素包括年龄>75 岁（优势比[OR]，1.85；P<.001）、体重指数>35kg/m（OR，1.63；P=.004）、充血性心力衰竭史（OR，2.47；P=.002）、糖尿病（OR，2.0；P<.001）和肾脏疾病（OR，2.28；P=.005）。
参与替代支付模式的提供者应该意识到再入院导致的捆绑费用增加，尤其是由于翻修手术。改善与患者的沟通和密切的术后监测可能有助于最大限度地减少在不同医疗机构的高比例再入院。
