Christensen Thomas H, Bieganowski Thomas, Malarchuk Alex W, Davidovitch Roy I, Bosco Joseph A, Schwarzkopf Ran, Macaulay William B, Slover James D, Lajam Claudette M
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2023 Feb;38(2):203-208. doi: 10.1016/j.arth.2022.08.019. Epub 2022 Aug 17.
Removal of primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA) from the inpatient-only list has financial implications for both patients and institutions. The aim of this study was to evaluate and compare financial parameters between patients designated for inpatient versus outpatient total joint arthroplasty.
We reviewed all patients who underwent TKA or THA after these procedures were removed from the inpatient-only list. Patients were statistical significance into cohorts based on inpatient or outpatient status, procedure type, and insurance type. This included 5,284 patients, of which 4,279 were designated inpatient while 1,005 were designated outpatient. Patient demographic, perioperative, and financial data including per patient revenues, total and direct costs, and contribution margins (CMs) were collected. Data were compared using t-tests and Chi-squared tests.
Among Medicare patients receiving THA, CM was 89.1% lower for the inpatient cohort when compared to outpatient (P < .001), although there was no statistical significance difference between cohorts for TKA (P = .501). Among patients covered by Medicaid or Government-managed plans, CM was 120.8% higher for inpatients receiving THA (P < .001) when compared to outpatients and 136.3% higher for inpatients receiving TKA (P < .001).
Our analyses showed that recent costs associated with inpatient stay inconsistently match or outpace additional revenue, causing CM to vary drastically depending on insurance and procedure type. For Medicare patients receiving THA, inpatient surgery is financially disincentivized leaving this vulnerable patient population at a risk of losing access to care.
Retrospective Cohort Study.
将初次全膝关节置换术（TKA）和初次全髋关节置换术（THA）从仅住院治疗列表中移除，对患者和医疗机构都有财务影响。本研究的目的是评估和比较指定接受住院与门诊全关节置换术患者之间的财务参数。
我们回顾了在这些手术从仅住院治疗列表中移除后接受TKA或THA的所有患者。根据住院或门诊状态、手术类型和保险类型，将患者统计学意义上分为不同队列。这包括5284名患者，其中4279名被指定为住院患者，1005名被指定为门诊患者。收集了患者的人口统计学、围手术期和财务数据，包括每位患者的收入、总成本和直接成本以及边际贡献（CM）。使用t检验和卡方检验对数据进行比较。
在接受THA的医疗保险患者中，住院队列的CM比门诊队列低89.1%（P <.001），尽管TKA队列之间无统计学显著差异（P =.501）。在医疗补助或政府管理计划覆盖的患者中，接受THA的住院患者的CM比门诊患者高120.8%（P <.001），接受TKA的住院患者的CM比门诊患者高136.3%（P <.001）。
我们的分析表明，近期与住院相关的成本与额外收入不一致匹配或超过额外收入，导致CM因保险和手术类型而异。对于接受THA的医疗保险患者，住院手术在经济上缺乏激励，使这一脆弱患者群体面临失去医疗服务的风险。
回顾性队列研究。
