Department of Orthopaedic Surgery, Rush University, Chicago, Illinois.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Bone Joint Surg Am. 2022 Feb 2;104(3):255-264. doi: 10.2106/JBJS.21.00392.
Post-acute care remains a target for episode-of-care cost reduction following total hip arthroplasty (THA). The introduction of bundled payment models in the United States in 2013 aligned incentives among providers to reduce post-acute care resource utilization. Institution-level studies have shown increased rates of home discharge with substantial cost savings after adoption of bundled payment models; however, national data have yet to be reported. The purpose of this study was to evaluate national trends in post-acute care utilization and costs following primary THA over the last decade.
We reviewed the cases of 189,847 patients undergoing primary THA during 2010 through 2018 from the PearlDiver database. Annual trends in patient demographics, discharge disposition, and post-acute care resource utilization were evaluated. Post-acute care reimbursements were standardized to 2020 dollars and included outpatient visits, prescriptions, physical therapy, home health, inpatient rehabilitation, skilled nursing facilities, and any rehospitalizations or emergency department (ED) visits within 90 days of surgery.
From 2010 to 2018, the mean episode-of-care costs ($31,562 versus $24,188; p < 0.001) and overall post-acute care costs ($5,903 versus $3,485; p < 0.001) both declined. Post-acute care savings were primarily driven by reduced costs of skilled nursing facilities ($1,533 versus $627; p < 0.001), home health ($1,041 versus $763; p = 0.002), inpatient rehabilitation ($949 versus $552; p < 0.001), ED visits ($508 versus $102; p < 0.001), and rehospitalizations ($367 versus $179; p < 0.001). Post-acute care costs declined by $578 (p = 0.025) during 2010 to 2012, $768 (p = 0.038) during 2013 to 2015, and $884 (p = 0.020) during 2016 to 2018.
Over the last decade, the rate of home discharge after THA increased while rehospitalization and ED visit rates declined, resulting in a substantial decrease in total and post-acute care costs. Post-acute care costs declined most rapidly after the introduction of the new Medicare bundled payment programs in 2013 and 2016.
全髋关节置换术（THA）后，仍将康复护理作为医疗费用管理的目标。2013 年，美国推出了捆绑式支付模式，旨在激励医疗机构减少康复护理资源的利用。机构层面的研究表明，采用捆绑式支付模式后，出院回家的比例增加，同时大幅节省了成本；然而，目前尚未有全国性的数据报道。本研究旨在评估过去十年中，美国初次 THA 后康复护理利用和成本的全国性趋势。
我们从 PearlDiver 数据库中检索了 2010 年至 2018 年间 189847 例初次 THA 患者的病例。评估了患者人口统计学特征、出院去向和康复护理资源利用的年度变化。将康复护理费用（2020 年美元）标准化，包括门诊就诊、处方、物理治疗、家庭健康、住院康复、熟练护理设施以及术后 90 天内的任何再住院或急诊（ED）就诊。
2010 年至 2018 年，医疗费用（31562 美元比 24188 美元；p < 0.001）和总体康复护理费用（5903 美元比 3485 美元；p < 0.001）均有所下降。康复护理费用的节省主要来自熟练护理设施（1533 美元比 627 美元；p < 0.001）、家庭健康（1041 美元比 763 美元；p = 0.002）、住院康复（949 美元比 552 美元；p < 0.001）、ED 就诊（508 美元比 102 美元；p < 0.001）和再住院（367 美元比 179 美元；p < 0.001）。2010 年至 2012 年，康复护理费用下降了 578 美元（p = 0.025），2013 年至 2015 年下降了 768 美元（p = 0.038），2016 年至 2018 年下降了 884 美元（p = 0.020）。
过去十年中，THA 后出院回家的比例增加，而再住院和 ED 就诊的比例下降，导致总医疗费用和康复护理费用大幅下降。新的医疗保险捆绑式支付计划于 2013 年和 2016 年推出后，康复护理费用下降速度最快。
