Avant-garde Health, Boston, MA.
Penn State Bone and Joint Institute and Penn State College of Medicine, Hershey, PA.
J Arthroplasty. 2020 Jun;35(6S):S33-S36. doi: 10.1016/j.arth.2020.01.074. Epub 2020 Feb 4.
Centers for Medicare and Medicaid Services removed total knee arthroplasties (TKAs) from the Inpatient-Only list on January 1, 2018, which meant TKAs could be performed on a hospital outpatient basis. We sought to understand (1) what the financial implications have been for hospitals, (2) to what extent financial incentives have influenced the adoption of outpatient TKAs across hospitals, (3) whether adoption of outpatient TKAs has impacted the success of hospitals with managing post-acute care (PAC) spend, and (4) the financial implications to Medicare of the adoption of outpatient TKAs.
We used national patient-level Medicare fee-for-service Part A claims data (100% sample) from January 2018 through June 2019 to calculate the inpatient and outpatient TKA payment rate for each hospital, and the distribution in these payments across the country. We then ran case-level regressions to understand the factors associated with adoption of outpatient TKAs, and the drivers of PAC spend. Finally, we quantified the savings to Medicare.
Hospitals on average received $3682 (30%) lower payment from Medicare for outpatient TKA cases, but this varied widely across hospitals. The difference in payment rates across hospitals was not statistically significantly related to their adoption rate of outpatient TKAs. PAC spend was higher for same-day discharges, but lower for cases that stayed at least 1 night. Based on the adoption rate of outpatient TKAs in Q2 2019, Medicare saved $355M on a run rate basis.
Hospitals have adopted outpatient TKAs independent of the financial impact. Medicare has benefited from lower PAC spend and lower payments to hospitals.
2018 年 1 月 1 日，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）将全膝关节置换术（TKA）从仅限住院治疗的名单中移除，这意味着 TKA 可以在医院门诊进行。我们试图了解：（1）这对医院的财务有何影响；（2）医院在多大程度上受到经济激励的影响而采用门诊 TKA；（3）门诊 TKA 的采用是否影响了医院管理急性后期护理（PAC）支出的成功；以及（4）门诊 TKA 的采用对医疗保险的财务影响。
我们使用了 2018 年 1 月至 2019 年 6 月的全国性患者级医疗保险费用服务 A 部分索赔数据（100%样本），计算了每家医院的门诊和住院 TKA 支付率，以及这些支付率在全国的分布情况。然后，我们进行了病例级回归，以了解与门诊 TKA 采用相关的因素，以及 PAC 支出的驱动因素。最后，我们量化了医疗保险的节省。
医院平均从医疗保险处获得的门诊 TKA 病例支付额低了 3682 美元（30%），但各医院之间的差异很大。医院之间的支付率差异与他们采用门诊 TKA 的比率没有统计学上的显著关系。同一天出院的 PAC 支出较高，但至少住一晚的病例支出较低。根据 2019 年第二季度门诊 TKA 的采用率，医疗保险按常规计算节省了 3.55 亿美元。
医院独立于经济影响而采用了门诊 TKA。医疗保险受益于 PAC 支出的降低和对医院支付额的降低。
