Department of Orthopaedic Surgery, Rush University, Chicago, IL.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2021 Jul;36(7):2268-2275. doi: 10.1016/j.arth.2021.01.021. Epub 2021 Jan 15.
Post-acute care continues to represent a target for cost savings with increasing popularity of value-based payment models in total knee arthroplasty (TKA). Rapid recovery and accelerated rehabilitation protocols have been successful in reducing costs at the institutional level, but national trends are less clear. This study aimed to determine if advancements in perioperative care led to a reduction in post-acute care costs and resource utilization following TKA.
We reviewed a consecutive series of 79,843 primary TKA patients from the Humana claims dataset from 2007 to 2016. Post-acute care costs included any claims within 90 days of surgery for subacute or inpatient rehabilitation, home health, outpatient or emergency visits, prescription medications, physical therapy, and readmissions. Demographics, episode-of-care and post-acute care costs, readmissions, and discharge disposition were compared. Controlling for demographics and comorbidities, multivariate regression analyses were performed to compare trends in discharge disposition and post-acute care costs.
From 2007 to 2016, the average episode-of-care costs ($46,754 vs $31,856) and post-acute care costs per patient decreased ($20,224 vs $13,498). Rates of discharge to skilled nursing facilities (25.0% vs 22.5%) and inpatient rehabilitation also declined (12.4% vs 2.1%). Readmissions also decreased (8.1% vs 7.1%) saving an average of $324 per patient. When compared to 2007-2012, total costs declined most rapidly after 2013 primarily due to a $3516 (21%) decrease in post-acute spending.
There has been a substantial decline in post-acute care costs and resource utilization following TKA, with the largest decrease occurring following the introduction of Medicare bundled payment models in 2013.
随着基于价值的支付模式在全膝关节置换术（TKA）中越来越受欢迎，康复后护理仍然是节省成本的目标。快速康复和加速康复方案已成功降低了机构层面的成本，但国家趋势尚不清楚。本研究旨在确定围手术期护理的进步是否导致 TKA 后康复后护理成本和资源利用的降低。
我们回顾了 2007 年至 2016 年 Humana 索赔数据集中的 79843 例原发性 TKA 患者的连续系列。康复后护理费用包括手术 90 天内的任何亚急性或住院康复、家庭健康、门诊或急诊就诊、处方药、物理治疗和再入院的费用。比较了人口统计学、治疗过程和康复后护理费用、再入院和出院情况。控制人口统计学和合并症后，进行多变量回归分析以比较出院情况和康复后护理费用的趋势。
从 2007 年到 2016 年，治疗过程的平均费用（46754 美元对 31856 美元）和每位患者的康复后护理费用（20224 美元对 13498 美元）均有所下降。到熟练护理机构（25.0%对 22.5%）和住院康复的出院率也有所下降（12.4%对 2.1%）。再入院率也有所下降（8.1%对 7.1%），每位患者平均节省 324 美元。与 2007-2012 年相比，2013 年后总成本下降最快，主要原因是康复后支出减少了 3516 美元（21%）。
TKA 后康复后护理成本和资源利用大幅下降，2013 年引入医疗保险捆绑支付模式后下降幅度最大。
