From the Yale Department of Orthopedics and Rehabilitation, New Haven, CT.
J Am Acad Orthop Surg. 2021 Dec 15;29(24):1061-1067. doi: 10.5435/JAAOS-D-20-01228.
Centers for Medicare & Medicaid Services (CMS) removed total knee arthroplasty (TKA) from the "inpatient-only" list from January 1, 2018. The impact of this change on actual hospital length of stay (LOS) and patient coding is of interest.
Patients undergoing TKA were abstracted from the 2015 to 2018 National Surgical Quality Improvement Program database. Patient characterization as "inpatient" or "outpatient" and actual LOS were assessed. Ordinal and categorical data comparisons were done with Pearson chi-squared tests. Continuous variables were tested for normality, and nonparametric analyses were conducted using the Mann-Whitney test. Significance was set at P < 0.05.
In total, 125,613 TKA patients from 2017 to 2018 were identified (232,269 TKA patients from 2015 to 2018). Most patients undergoing TKA were of Medicare eligibility (≥65 years old; 60.78% in 2017 and 62.42% in 2018). Overall, LOS decreased significantly from 2017 to 2018 (2.31 ± 1.56 days versus 2.05 ± 1.57 days; P < 0.001), and more patients were discharged the same day (5.09% versus 2.28%; P < 0.001). In 2017, patients were coded as "outpatient" 1.66% of the time (those with LOS = 0 days were 22.85%, LOS = 1 day were 1.80%, LOS = 2 days were 0.79%, and LOS ≥3 days were 0.85%). In 2018, patients were coded as "outpatient" 17.14% of the time (those with LOS = 0 days were 78.2%, LOS = 1 day were 29.75%, LOS = 2 days were 6.96%, and LOS ≥3 days were 3.05%). This represented a significant change for each LOS day (P < 0.001). These results remained true when stratifying by Medicare eligibility (P < 0.001 for those <65 years old and those ≥65 years old).
After the 2018 removal of TKA from the CMS "inpatient-only" list, patients were more likely to be discharged the same day and be considered "outpatients." Patients with more prolonged LOS and those younger than 65 years were more likely to have been coded as "outpatient" in 2018 compared with 2017. These data demonstrate that national changes in CMS policies can have broad impact on overall practice patterns.
Retrospective cohort study.
从 2018 年 1 月 1 日起，医疗保险和医疗补助服务中心（CMS）将全膝关节置换术（TKA）从“仅限住院”清单中移除。这项变化对实际住院时间（LOS）和患者编码的影响值得关注。
从 2015 年至 2018 年的国家手术质量改进计划数据库中提取接受 TKA 的患者。评估患者的“住院”或“门诊”特征以及实际 LOS。使用 Pearson 卡方检验进行有序和分类数据比较。连续变量进行正态性检验，使用 Mann-Whitney 检验进行非参数分析。显著性水平设定为 P < 0.05。
2017 年至 2018 年共确定了 125613 例 TKA 患者（2015 年至 2018 年共 232269 例 TKA 患者）。大多数接受 TKA 的患者符合医疗保险资格（≥65 岁；2017 年为 60.78%，2018 年为 62.42%）。总体而言，2017 年至 2018 年 LOS 显著缩短（2.31±1.56 天与 2.05±1.57 天；P<0.001），更多患者当天出院（5.09%与 2.28%；P<0.001）。2017 年，患者被编码为“门诊”的比例为 1.66%（LOS=0 天的患者为 22.85%，LOS=1 天的患者为 1.80%，LOS=2 天的患者为 0.79%，LOS≥3 天的患者为 0.85%）。2018 年，患者被编码为“门诊”的比例为 17.14%（LOS=0 天的患者为 78.2%，LOS=1 天的患者为 29.75%，LOS=2 天的患者为 6.96%，LOS≥3 天的患者为 3.05%）。这在每个 LOS 日都有显著变化（P<0.001）。当按医疗保险资格分层时，这些结果仍然成立（<65 岁和≥65 岁的患者均 P<0.001）。
自 2018 年 CMS 将 TKA 从“仅限住院”清单中移除后，患者更有可能当天出院并被视为“门诊”患者。与 2017 年相比，2018 年 LOS 较长和年龄小于 65 岁的患者更有可能被编码为“门诊”。这些数据表明，CMS 政策的全国性变化对整体实践模式有广泛影响。
回顾性队列研究。
