06 Apr Readmissions After Hip or Knee Replacement Are Costly
Medical Research: What is the background for this study?
Dr. Bosco: NYU Langone’s Hospital for Joint Diseases was one of the first institutions selected to participate in a Bundled Payment Care Initiative for total joint patients. For this three-year pilot program, the hospital is given an initial payment by Medicare that covers costs accrued 72 hours prior to admission, the inpatient stay, post-acute care, and any additional costs incurred up to 90-days following discharge, including readmissions.
The goal of the initiative, from the Centers for Medicare & Medicaid Services (CMS) is to improve cost transparency and lower the cost of Medicare by bundling payments for quality of care, rather than quantity of procedures ordered. Hospitals are penalized if the patient returns and there are any complications.
We studied the costs of readmissions for surgical and medical complications within a 90-day episode of care for Bundled Payment Care Initiative patients receiving total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Identifying the causes for readmission and assessing the costs of those readmissions will guide quality improvement.
Medical Research: What are the main findings?
Dr. Bosco: There were 721 total patients who underwent these procedures during the time period of the study. 80, or 11 percent, were readmitted within 90-days. These complications for readmitted patients included infection (11), wound complications (8), bleeding (7), periprosthetic fracture (5), dislocations (4), and post-surgical pain (4), with an average cost of $36,038 (range $6,375-$60,137) for THA and $61,049 (range $26,740-$186,069) for total knee arthroplasty. When two outliers of greater than $100,000 are eliminated, the average cost of a surgical TKA readmission was $32,922 (range $26,740-$40,774).
Medical Research: What should clinicians and patients take away from your report?
Dr. Bosco: You want to prevent any readmissions as much as possible and come up with a course ahead of time of what patient should expect before and after an operation, and what patient should do in the event they’re experiencing a complication.
Physicians and health care facilities should develop protocols to prevent readmissions and manage their patients’ expectations. For any issues, patients should be told to call the office emergency line or a physician’s cell phone, and not go to emergency room or call 9-11. Many of these readmissions can be prevented, and often emergency room clinicians may not be aware of how to best manage the complications.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Bosco: Going forward, knowing what the causes are for readmission and what the financial implications are from these cases will help hospitals better assess a patient’s risk preoperatively. Physicians can better control any of a patient’s medical comorbidities in order to prevent complications post-operatively, and readmissions.
AAOS 2015 abstract:
MedicalResearch.com Interview with: Dr. Joseph Bosco MD III (2015). Readmissions After Hip or Knee Replacement Are Costly