OrthoCarolina Hip and Knee Center, Charlotte, NC.
J Arthroplasty. 2019 Jul;34(7S):S121-S124. doi: 10.1016/j.arth.2019.02.053. Epub 2019 Feb 27.
The Centers for Medicare and Medicaid Services beginning in 2013 introduced the Bundled Payments for Care Improvement (BPCI) initiative to test innovative payment and service delivery models. Early implementers of the BPCI program have shown decreased hospital length of stays, discharges to inpatient facilities, and readmission rates with overall cost savings. Removal of total knee arthroplasty from the Medicare inpatient-only list may potentially cause substantial changes in patients included in BPCI bundles in 2018.
The 2017 Centers for Medicare and Medicaid Services data were used to compare total expenditures of diagnosis-related groups 469 and 470. Medicare patients who underwent total knee arthroplasty between January 2017 and December 2017 were defined as group one (n = 1024) and expenditures were compared to group two patients (n = 631) that included only those patients staying greater than 24 hours. Postacute events within the 90-day episode including admission to an inpatient rehabilitation facility/skilled nursing facility (SNF), home health (HH), and readmissions were analyzed. Expenditures were converted to 2018 dollars using Consumer Price Index. Statistical analysis of expenditures was performed with Wilcoxon Tests.
Median expenditures were $15,587 (interquartile range [IQR] $13,915-$17,684) for group 1 and $16,706 (IQR $15,333-$19,247) for group 2 (P < .001). Median postacute care spend was $3817 (IQR $2431-$5057) for group 1 and $4195 (IQR $3049-$6064) for group 2 patients (P < .001). Compared with group 1 patients, group 2 patients had a higher rate of SNF admissions (21% vs 13%), inpatient rehabilitation facility admissions (0.16% vs 0.1%), HH (72% vs 69%), and readmissions (5% vs 4%).
Implications of the removal of total knee arthroplasty from the inpatient-only list could potentially remove up to 40% of patients from the BPCI program leading to substantially less savings on average $1100 per patient. Remaining bundle patients are also more likely to require HH and SNF after discharge.
自 2013 年起，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）推出了“改善护理捆绑支付（Bundled Payments for Care Improvement）”计划，以测试创新的支付和服务交付模式。早期实施 BPCI 计划的机构已经显示出住院时间、住院设施出院率和再入院率有所下降，同时实现了整体成本节约。将全膝关节置换术从医疗保险仅限住院治疗的清单中移除，可能会对 2018 年 BPCI 捆绑包中包含的患者产生重大影响。
使用 2017 年医疗保险和医疗补助服务中心的数据，比较了诊断相关组 469 和 470 的总支出。2017 年 1 月至 12 月期间接受全膝关节置换术的医疗保险患者被定义为第一组（n=1024），并将支出与仅包括住院时间超过 24 小时的第二组患者（n=631）进行比较。在 90 天发病期内的后续急性事件，包括入住住院康复机构/熟练护理设施（SNF）、家庭保健（HH）和再入院情况，进行了分析。支出使用消费者价格指数转换为 2018 年美元。采用 Wilcoxon 检验对支出进行统计学分析。
第一组的中位数支出为 15587 美元（四分位距[IQR]为 13915-17684 美元），第二组为 16706 美元（IQR 为 15333-19247 美元）（P<.001）。第一组的后续急性护理支出中位数为 3817 美元（IQR 为 2431-5057 美元），第二组为 4195 美元（IQR 为 3049-6064 美元）（P<.001）。与第一组患者相比，第二组患者 SNF 入院率更高（21%比 13%），住院康复机构入院率更高（0.16%比 0.1%），HH 使用率更高（72%比 69%），再入院率更高（5%比 4%）。
将全膝关节置换术从仅限住院治疗的清单中移除的影响可能会使多达 40%的患者从 BPCI 计划中移除，导致每位患者平均节省 1100 美元左右。剩余的捆绑包患者在出院后也更有可能需要 HH 和 SNF。
