Kelmer Grayson C, Turcotte Justin J, Dolle Steffanie S, Angeles Jeanne D, MacDonald James H, King Paul J
Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, MD.
J Arthroplasty. 2021 Aug;36(8):2651-2657. doi: 10.1016/j.arth.2021.03.016. Epub 2021 Mar 10.
Nurse navigation programs have been previously shown to reduce cost and improve outcomes after total joint arthroplasty (TJA). Medicare has proposed a 13.7% reduction in professional fee reimbursement for TJA procedures that may adversely impact providers' and health systems' ability to fund ancillary support resources such as nurse navigators.
A consecutive series of primary TJAs performed between April 2019 and February 2020 was retrospectively reviewed. Clinical and financial outcomes of patients attending a nurse navigator-led preoperative education class were compared with those who did not attend.
There were 2057 TJAs identified during the study period. Most patients attended the preoperative education class (82.7%) and were discharged home (92.8%). Controlling for significant differences between groups, class attendance was associated with reduced length of stay (LOS), increased chance of 0- or 1-day LOS, reduced chance of discharge to a skilled nursing facility, and reduced hospital charges. For this patient sample, a proposed 13.7% reduction in nurse navigator-led classes was modeled to increase overall cost to payers by >$400,000 annually. Complete elimination of this class was estimated to increase the total annual cost by >$5,700,000 and cost per TJA by >$2700.
The use of a nurse navigator-led preoperative education class was associated with shorter LOS, more frequent 0- and 1-day LOS, reduced discharge to skilled nursing facilities, and lower total hospital charges for those patients who attended. Potential reductions proposed by Medicare may interfere with the ability to support such services and negatively impact both clinical and financial outcomes.
先前的研究表明，护士导航项目可降低全关节置换术（TJA）后的成本并改善治疗效果。医疗保险计划提议将TJA手术的专业费用报销降低13.7%，这可能会对医疗服务提供者和医疗系统为护士导航员等辅助支持资源提供资金的能力产生不利影响。
回顾性分析了2019年4月至2020年2月期间连续进行的一系列初次TJA手术。将参加由护士导航员主导的术前教育课程的患者的临床和财务结果与未参加的患者进行比较。
在研究期间共识别出2057例TJA手术。大多数患者参加了术前教育课程（82.7%）并出院回家（92.8%）。在控制组间显著差异后，参加课程与住院时间缩短、住院0天或1天的几率增加、转至熟练护理机构的几率降低以及医院费用降低相关。对于该患者样本，模拟了护士导航员主导课程提议的13.7%的削减，预计每年会使支付方的总成本增加超过40万美元。完全取消该课程估计每年总成本会增加超过570万美元，每例TJA手术成本增加超过2700美元。
对于参加课程的患者，由护士导航员主导的术前教育课程与住院时间缩短、0天和1天住院情况更频繁、转至熟练护理机构的情况减少以及医院总费用降低相关。医疗保险计划提议的潜在削减可能会干扰支持此类服务的能力，并对临床和财务结果产生负面影响。
