ORTHOPEDICS: 30-day readmission rates for total hip and total knee replacement

The readmission rate for total hip replacement and total knee replacement procedures performed recently on patients in California, Florida and Massachusetts was studied.  Here are the findings for the percent of these patients readmitted within 30 days:

• 4.29 percent (California during the period 2009 to 2011)
• 4.7 percent (Florida during the period 2009 to 2013)
• 3.92 percent (Massachusetts during the period 2009 to 2012)

The authors analyzed the role of infection in these 30-day readmissions, finding that in about one-third of the total hip and total knee arthroplasty patients, infection was listed as the primary or secondary reason for readmission.

Source: A retrospective study. Medicine, 96(38). Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617700/pdf/medi-96-e7961.pdf  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