Abstract Introduction To curb the unsustainable rise in healthcare expenses, healthcare payers are developing programs to incentivize hospitals and physicians to improve the value of care delivered ...to patients. Payers are utilizing various metrics, such as length of stay and unplanned readmissions, to track progression of quality metrics. Relevant to orthopaedic surgeons, the Centers for Medicare and Medicaid Services (CMS) announced in 2015 the Comprehensive Care for Joint Replacement Payment Model (CJR)–a program aimed at improving the quality of healthcare delivered to patients by shifting more of the financial risk of patient care onto providers. Methods We analyzed the medical records of 1,329 consecutive lower extremity total joint patients enrolled in CMS’s Bundled Program for Care Improvement (BPCI) treated over a 21-month period. The goal of this study was to ascertain if hospital length of stay is associated with unplanned readmissions within 90 days of admission for a total hip or knee arthroplasty. Results After controlling for multiple demographic variables including sex, age, comorbidities and discharge location, we found that hospital length of stay greater than 4 days is a significant risk factor for unplanned readmission within 90 days (OR = 1.928, p = 0.010). Total knee arthroplasty and discharge to a location other than home are also independent risk factors for 90-day readmission. Conclusion Our results demonstrate that increased length of stay is a significant risk factor for readmission within 90 days of admission for a hip or knee arthroplasty in the Medicare population.
Abstract Introduction Hip Arthroplasty is increasingly performed as a treatment for femoral neck fractures (FNF). However, these cases have higher complication rates than elective total hip ...replacements (THA). The Center for Medicare and Medicaid Services has created the Comprehensive Care for Joint Replacement (CJR) model to increase the value of patient care. This model risk stratifies FNF patients in an attempt to appropriately allocate resources, but the formula has not been disclosed. The goal of this study was to ascertain if patients with FNFs have different readmission rates compared to patients undergoing elective THA so that the resource utilization can be assessed. Methods We analyzed all patients undergoing THA at our institution during a 21-month period. Patients classified by a diagnosis-related group (DRG) of 469 or 470 were included. Multivariate and survival analyses were performed to determine risk of 90-day readmission. Results Patients admitted for FNFs were older, had higher BMIs, longer lengths of stay and were more likely to be discharged to inpatient facilities than patients who underwent elective THA. Increased American Society of Anesthesiologists (ASA) Scores and FNF were also independent risk factors for 90-day readmission, and these patient were more likely to be readmitted during the latter 60-days following admission Conclusion Results suggest that patients who undergo an arthroplasty following urgent or emergent femoral neck fractures have inferior outcomes to those receiving an arthroplasty for a diagnosis of arthritis. Fracture patients should either be risk stratified to allow appropriate resource allocation or be excluded from alternative payment initiatives like CJR.
