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TRENDS: nearly 450,000 hip replacements each year

The U.S. Agency for Healthcare Research and Quality (AHRQ) has a number of free databases on the web that can be used to take an interesting historical look at health care utilization data.  I recently posted on this blog about hip fracture – and got an unusual number of hits! – so thought I might explore another aspect of the same topic here using some AHRQ data.

HIP REPLACEMENT: Inpatients discharged who had total or partial hip replacement, 1995-2013

  • 267,034 (or 100.3 per 100,000 persons) in 1995
  • 298,631 (or 105.8 per 100,000 persons) in 2000
  • 371,754 (or 125.8 per 100,000 persons) in 2005
  • 439,838 (or 142.2 per 100,000 persons in 2010
  • 439,945 (or 156.2 per 100,000 persons) in 2013

The fine print: What is this exactly?  First of all, these numbers represent inpatients only.  The rates per 100,000 persons means per 100,000 resident population.  The data source is the National Inpatient Sample based on the “CCS category” code 153: Hip replacement, total and partial.  It is also possible to run data using ICD-9 codes or DRGs.  The most current data year is 2013.

We notice from these data that both the actual number of inpatients who have had hip replacement and the rate per 100,000 persons are trending upward over time.

HIP REPLACEMENT: Ambulatory surgery?

AHRQ also has a database of ambulatory surgery procedures for 29 reporting states (representing two-thirds of the U.S. population).  As of this writing, the database can be queried for just the year 2012 but, with an added nice feature, provides comparable inpatient data for the same states.  Setting this database up for the same CCS category as above (153: Hip replacement, total and partial, all listed) shows that only about 3 percent of hip replacements were done on an outpatient basis in 2012.

Source: Agency for Healthcare Research and Quality. Welcome to HCUPnet. Click here for free access to this database http://hcupnet.ahrq.gov/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HIP REPLACEMENT: You might have to go to school first

Total joint replacement procedures – hips and knees – are commonly performed on Medicare patients, costing an estimated $7 billion annually for the hospital care alone.  The Centers for Medicare & Medicaid Services (CMS) has developed a bundled payment pilot initiative with mandatory participation for 67 selected health care markets nationwide.  One cost-reduction approach that is being tried by several providers is the idea of having elective hip and knee patients go to an “academy,” or otherwise receive patient education, before surgery to remove or lessen risk factors that might complicate their recovery.  Among the hospitals and health systems trying this out are: DCH Regional Health System (Tuscaloosa, Ala.), Catholic Health Initiatives (Englewood, Colo.), and BayCare Health (Clearwater, Fla.).

For more information about the CMS initiative, click here: https://innovation.cms.gov/initiatives/cjr

Source: Evans, M. (2016, Mar. 28). Ready or not, the bundled-payment challenge is about to start. Modern Healthcare, 46(13), 8-9.  Click here for publisher’s website: http://www.modernhealthcare.com/article/20160326/MAGAZINE/303269996  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ORTHOPEDICS: Trends in total joint replacement surgery

In step with the aging of the U.S. population, the number of total hip and total knee replacement procedures is increasing.  In Pennsylvania, which has had for years an independent state agency charged with collecting comparative information about the cost of care, newly published data quantify this trend.

Total Joint Replacement Procedures in Pennsylvania: 2004-2013

  • 46.1 percent increase (total hip replacement)
  • 34.9 percent increase (total knee replacement)

30-Day Readmission Rate: Pennsylvania: 2013

  • 4.3 percent (total hip replacement)
  • 3.9 percent (total knee replacement)

Volume-Outcome Relationship (there is a lot of literature on this topic…)

  • “While not applicable to an individual surgeon, in general, higher surgeon volume was associated with a patient’s decreased risk of being readmitted within 30 days after knee or hip replacement (after accounting for patient risk). Higher hospital volume was not associated with the risk of being readmitted.” (p. 11)

An interesting feature of this report is data on specific hospitals for total hip and total knee cases, 30-day readmission rate, and average charge.  There are also data on number of total hip and total knee cases for specific surgeons – and how this volume is divided among the different hospitals that each of the orthopedic surgeons operate at.  Another table compares, by hospital, the average charge and the average Medicare payment rate.

Source: Pennsylvania Health Care Cost Containment Council. (2015, June). Knee and hip replacements: 2013 data. Retrieved from http://www.phc4.org/reports/kneehip/13/docs/Knee-Hip-Replacement-Report-2015.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org