scholarly journals ESTIMATING HOSPITAL COSTS FOR BUPIVACAINE LIPOSOMAL INJECTABLE SUSPENSION IN MEDICARE PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY USING PREMIER CHARGEMASTER DATA

2016 ◽  
Vol 19 (3) ◽  
pp. A230
Author(s):  
S. Dagenais ◽  
A. Kang ◽  
R. Scranton
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Costs ◽  
Medicare Patients ◽  
Total Knee

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

2020 ◽  
Author(s):  
Stephen Thomas ◽  
Ankur Patel ◽  
Corey Patrick ◽  
Gary Delhougne
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Cost ◽  
Readmission Rate ◽  
Hospital Costs ◽  
Patient Specific ◽  
P Value ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

2020 ◽  
Author(s):  
Sean S. Rajaee ◽  
Eytan M. Debbi ◽  
Guy D. Paiement ◽  
Andrew I. Spitzer
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Smoking Status ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
The United States ◽  
Bundled Payment ◽  
Vein Thrombosis ◽  
Total Knee ◽  
Payment Models

AbstractGiven a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were compared. There was a significant increase in the rate of smoking in TKA from 17.9% in 2012 to 19.2% in 2014 (p < 0.0001). The highest rate was seen in patients < 45 years of age (27.3%). Hospital resource usage was significantly higher for smokers, with a length of stay of 3.3 versus 2.9 days (p < 0.0001), and hospital costs of $16,752 versus $15,653 (p < 0.0001). A multivariable logistic model adjusting for age, gender, and comorbidities showed that smokers had an increased odds ratio for myocardial infarction (5.72), cardiac arrest (4.59), stroke (4.42), inpatient mortality (4.21), pneumonia (4.01), acute renal failure (2.95), deep vein thrombosis (2.74), urinary tract infection (2.43), transfusion (1.38) and sepsis (0.65) (all p < 0.0001). Smoking is common among patients undergoing elective TKA, and its prevalence continues to rise. Smoking is associated with higher hospital costs as well as higher rates of immediate inpatient complications. These findings are critical for risk stratification, improving of bundled payment models as well as patient education, and optimization prior to surgery to reduce costs and complications.

2020 John N. Insall Award: Removal of total knee arthroplasty from the inpatient-only list adversely affects bundled payment programmes

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 19-23 ◽  
Author(s):  
Michael Yayac ◽  
Nicholas Schiller ◽  
Matthew S. Austin ◽  
P. Maxwell Courtney
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Inpatient ◽  
Target Price ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Medicare Patients ◽  
Total Knee ◽  
Care Improvement ◽  
The Impact

Aims The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018. Methods We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data. Demographics, comorbidities, and outcomes were compared between patients classified as ‘outpatient’ and ‘inpatient’ TKA. Episode-of-care BPCI costs were then compared from 2017 to 2018. Results Of the 2,135 primary TKA patients in 2018, 908 (43%) were classified as an outpatient and were excluded from BPCI. Inpatient classified patients had longer mean length of stay (1.9 (SD 1.4) vs 1.4 (SD 1.7) days, p < 0.001) and higher rates of discharge to rehabilitation (17% vs 3%, p < 0.001). Post-acute care costs increased when comparing the BPCI patients from 2017 to 2018, ($5,037 (SD $7,792) vs $5793 (SD $8,311), p = 0.010). The removal of TKA from the IPO list turned a net savings of $53,805 in 2017 into a loss of $219,747 in 2018 for our BPCI programme. Conclusions Following the removal of TKA from the IPO list, nearly half of the patients at our institution were inappropriately classified as an outpatient. Our target price was increased and our institution realized a substantial loss in 2018 BPCI despite strong quality metrics. CMS should address its negative implications on bundled payment programmes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):19–23.

scholarly journals Outcomes of Medicare Outpatient Total Knee Arthroplasty at an Ambulatory Surgery Center

2021 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Daniel Lo
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Ambulatory Surgery ◽  
Medicare Beneficiaries ◽  
Total Recovery ◽  
Ambulatory Surgery Centers ◽  
Patient Reported ◽  
Medicare Patients ◽  
Total Knee

Background: Total knee arthroplasty (TKA) was removed from the “inpatient only” list for Medicare Beneficiaries in 2018. As a result, outpatient TKA’s have been performed at ambulatory surgery centers (ASC) more frequently. This study aims to evaluate outcomes of medicare patients who underwent outpatient TKA at an ASC. Methods: We conducted a retrospective cohort review of medicare patients who underwent TKA at an ASC between January 1st, 2020 and June 30th, 2020 performed by six orthopedic surgeons. Results: Thirty-six patients were identified who underwent primary TKA. There was a mean age of 72.4 and body mass index of 30.9. The mean preoperative range of motion was -6.7 degrees of extension and 114.8 degrees of flexion, two and six week post operative extension of -3.8 degrees and flexion of 104 degrees and -2.7 degrees and 114.6 degrees respectively. Preoperative physical and mental patient reported outcomes measurement and information system scores were 43.2 and 53.4 respectively and 49.4 and 53.1 post operatively. Preoperative patient reported outcomes measure with the knee injury and osteoarthritis outcome score was 48.4 and 72.8 post operatively. There were two patients (5.5%) with complications of arthrofibrosis that required manipulation under anesthesia. Total recovery time and time within the ASC were on average 200 minutes and 398.6 minutes respectively. Conclusion: Without adverse events within the first six months, this study suggests that outpatient TKA can be safely performed in medicare patients at an ASC.

Predictors of Discharge Settings After Total Knee Arthroplasty in Medicare Patients

2020 ◽  
Vol 101 (9) ◽  
pp. 1509-1514
Author(s):  
Rodney Laine Welsh ◽  
Dana L. Wild ◽  
Amol M. Karmarkar ◽  
Natalie E. Leland ◽  
Jacques G. Baillargeon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medicare Patients ◽  
Total Knee

scholarly journals Comorbidities in Patients Undergoing Total Knee Arthroplasty: Do They Influence Hospital Costs and Length of Stay?

2014 ◽  
Vol 472 (12) ◽  
pp. 3943-3950 ◽  
Author(s):  
Andrew J. Pugely ◽  
Christopher T. Martin ◽  
Yubo Gao ◽  
Daniel A. Belatti ◽  
John J. Callaghan
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Hospital Costs ◽  
Total Knee
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