Musculoskeletal Institute of Excellence, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI.
Rehab Institute of Michigan, Department of Rehabilitation, Detroit Medical Center, Detroit, MI.
J Arthroplasty. 2019 Nov;34(11):2532-2537. doi: 10.1016/j.arth.2019.06.041. Epub 2019 Jun 26.
Health care spending is projected to increase throughout the next decade alongside the number of total joint arthroplasties (TJAs) performed. Such growth places significant financial burden on the economic system. To address these concerns, Bundled Payments for Care Improvement (BPCI) is becoming a favorable reimbursement model. The aim of this study is to present the outcomes with BPCI model focused on the post-acute care (PAC) phase and compare the outcomes between years 1 and 2 of implementation.
The Joint Utilization Management Program (JUMP) was implemented in January 2014. Inclusion criteria were Medicare patients undergoing primary unilateral in-patient TJA procedures, outpatient procedures that resulted in an in-hospital admission, and trauma episodes that required TJA. Scorecards monitoring surgeons' performance and tracking length of stay (LOS) in the PAC setting were established. The data generated from these scorecards guided percentage sum-allocation from the total gain-shared sum among the participating providers.
A total of 683 JUMP patients were assessed over two years. PAC utilization decreased between 2014 and 2015. The average LOS was longer in year 1 than year 2 (4.50 vs 3.19 days). In-patient rehabilitation (IPR) decreased from 6.45% to 3.22%, with a decrease in IPR average LOS of 1.47 days. The rate of 30-day readmission was lower for JUMP patients in 2015 than 2014 (8.77% vs 10.56%), with day of readmission being earlier (11.91 days vs 13.71 days) in 2014.
Under the BPCI program, our experience with the JUMP model demonstrates higher efficiency of care in the PAC setting through reduced LOS, IPR admission rates, and 30-day readmission rate.
预计在未来十年内，随着全关节置换术 (TJA) 总数的增加，医疗保健支出将增加。这种增长给经济系统带来了巨大的财务负担。为了解决这些问题，改善护理的捆绑支付 (BPCI) 正在成为一种有利的报销模式。本研究旨在介绍以 BPCI 模型为重点的急性后期护理 (PAC) 阶段的结果，并比较实施第 1 年和第 2 年的结果。
联合利用管理计划 (JUMP) 于 2014 年 1 月实施。纳入标准为接受初次单侧住院 TJA 手术的 Medicare 患者、导致住院的门诊手术以及需要 TJA 的创伤发作。建立了监测外科医生绩效和跟踪 PAC 环境中住院时间 (LOS) 的记分卡。这些记分卡生成的数据指导了参与提供者之间从总收益共享总额中分配百分比总和。
在两年内评估了 683 名 JUMP 患者。PAC 利用率在 2014 年至 2015 年期间下降。第 1 年的平均 LOS 长于第 2 年 (4.50 对 3.19 天)。住院康复 (IPR) 从 6.45%下降到 3.22%，IPR 平均 LOS 下降了 1.47 天。2015 年 JUMP 患者的 30 天再入院率低于 2014 年 (8.77%对 10.56%)，再入院日更早 (11.91 天对 13.71 天)。
在 BPCI 计划下，我们在 JUMP 模型方面的经验表明，通过减少 LOS、IPR 入院率和 30 天再入院率，PAC 环境中的护理效率更高。
