在一个医生拥有的 Bundled Payments for Care Improvement（BPCI）项目中，将全膝关节置换术从仅住院治疗清单中移除所产生的财务影响。
Financial impact of removal of total knee arthroplasty from the inpatient-only list for a physician-owned BPCI program.
作者信息
Rizkalla James M, Bhimani Aamir A, Kitziger Kurt J, Peters Paul C, Schubert Richard D, Gladnick Brian P
机构信息
Baylor Univeristy Medical Center, Department of Orthopaedic Surgery, 3500 Gaston Ave, Dallas, TX, 75246, USA.
W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA.
出版信息
J Orthop. 2020 Jan 30;20:221-223. doi: 10.1016/j.jor.2020.01.045. eCollection 2020 Jul-Aug.
OBJECTIVE
Assessing financial effects of removal of TKA from CMS inpatient-only list on physician-owned bundles.
METHODS
We determined whether Medicare TKAs remained inpatient, versus changed to observational. We used CMS data to determine savings. Direct costs associated with BPCI were calculated.
RESULTS
7/28 TKAs (25.0%) had inpatient status changed to observational, excluding them from BPCI. Estimated savings losses were $24,332. Direct costs for administrating BPCI were $51,250. Had the rate of patients changed to observational been 50%, bundle savings from remaining patients would be less than direct costs.
CONCLUSION
Removing TKA from CMS inpatient-only list may have negative financial implications.
目的
评估将全膝关节置换术（TKA）从医疗保险和医疗补助服务中心（CMS）仅住院治疗列表中移除对医生拥有的捆绑支付模式的财务影响。
方法
我们确定医疗保险的全膝关节置换术是仍为住院治疗，还是改为观察性治疗。我们使用CMS的数据来确定节省的费用。计算了与基于 episode 的综合付费（BPCI）相关的直接成本。
结果
28例全膝关节置换术中的7例（25.0%）住院状态改为观察性治疗，从而被排除在基于 episode 的综合付费之外。估计节省费用损失为24,332美元。管理基于 episode 的综合付费的直接成本为51,250美元。如果改为观察性治疗的患者比例为50%，则剩余患者的捆绑支付节省费用将低于直接成本。
结论
将全膝关节置换术从CMS仅住院治疗列表中移除可能会产生负面的财务影响。
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