This study brings more questions to my mind.
Nonelective hip arthroplasties would probably be mainly due to a patient falling. Clinically it makes sense that the mortality rate is higher and that these individuals would be more likely to receive skilled nursing facility services. Without knowing the relevant factors, it seem reasonable to me that 72% of these patients receive skilled nursing facility services.
How low is a reasonable complication rate? I mean, 0% is unrealistic. What is realistic?
I'm also curious the reasons for readmissions. I would assume there would be overlap with complication rates.
I wonder how much change will happen with bundled payments.... and with that change will patients really receive the appropriate care even if it costs more and reduces the amount of profit.
Below you will find a quick view of the abstract.
In an effort to improve quality and reduce costs, payments are being increasingly tied to value through alternative payment models, such as episode-based payments. The objective of this study was to better understand the pattern and variation in outcomes among Medicare beneficiaries receiving lower extremity joint arthroplasty over 90-day episodes of care.
Observed rates of mortality, complications, and readmissions were calculated over 90-day episodes of care among Medicare fee-for-service beneficiaries who received elective knee arthroplasty and elective or nonelective hip arthroplasty procedures in 2013-2014 (N = 640,021). Post-acute care utilization of skilled nursing and inpatient rehabilitation facilities was collected from Medicare files.
Mortality rates over 90 days were 0.4% (knee arthroplasty), 0.5% (elective hip arthroplasty), and 13.4% (nonelective hip arthroplasty). Complication rates were 2.1% (knee arthroplasty), 3.0% (elective hip arthroplasty), and 8.5% (nonelective hip arthroplasty). Inpatient rehabilitation facility utilization rates were 6.0% (knee arthroplasty), 6.7% (elective hip arthroplasty), and 23.5% (nonelective hip arthroplasty). Skilled nursing facility utilization rates were 33.9% (knee arthroplasty), 33.4% (elective hip arthroplasty), and 72.1% (nonelective hip arthroplasty). Readmission rates were 6.3% (knee arthroplasty), 7.0% (elective hip arthroplasty), and 19.2% (nonelective hip arthroplasty). Patients' age and clinical characteristics yielded consistent patterns across all outcomes.
Outcomes in our national cohort of Medicare beneficiaries receiving lower extremity joint arthroplasties varied across procedure types and patient characteristics. Future research examining trends in access to care, resource use, and care quality over bundled episodes will be important for addressing the challenges of value-based payment reform.
J Arthroplasty. 2017 Mar 30. pii: S0883-5403(17)30276-0. doi: 10.1016/j.arth.2017.03.040. [Epub ahead of print]