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Found! A Way to Slash Costs After Total Joint Arthroplasty

by Elizabeth Hofheinz, M.P.H., M.Ed.

In the sexy world of healthcare economics, the heroes are those who find the money-saving opportunities. With the abundance of total joint arthroplasties (TJAs) being performed, finding ways to cut costs in that arena is a popular undertaking. Recently, a team of researchers from the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia delved into the issue of whether discharging primary TJA patients to skilled nursing facilities (SNFs) has the potential to reduce bundled payments costs.

Their work, “High-Quality Skilled Nursing Facilities Are Associated With Decreased Episode-of-Care Costs Following Total Hip and Knee Arthroplasty,” appears in the July 1, 2020 edition of The Journal of Arthroplasty.

Co-author P. Maxwell Courtney, M.D., an orthopedic surgeon at the Rothman Orthopaedic Institute, told OSN, “With the increasing popularity of bundled payments, there has been a push to send more patients home following total hip and knee replacement. There is still a subset of elderly patients, however, who may require a short stay at a rehabilitation facility after surgery. In Medicare bundled payment models, many skilled nursing facilities are not held accountable for their quality of care and length of stay in rehabilitation. Some facilities may try to keep patients in rehab as long as possible in order to maximize their revenue or send patients to the ER for unnecessary visits, but this has the adverse effect of driving up healthcare costs.”

The authors wrote, “…Claims data from Centers for Medicare and Medicaid Services were queried to identify patients discharged to SNF following primary total joint arthroplasty. We compared costs and outcomes between patients discharged to credentialed SNF sites and those discharged to other sites.”

“Between 2015 and 2018, of a consecutive series of 8778 primary THA and TKA patients, 1284 (14.6%) were discharged to an SNF. Following initiation of the program, 498 patients were discharged to an SNF, 301 (60.4%) of which were sent to a credentialed facility. Patients at credentialed facilities had significantly lower SNF costs ($11,184 vs $8198), PAC costs ($18,952 vs $15,148), and episode-of-care costs ($34,557 vs $30,831), with no difference in readmissions (10% vs 12%) or complications (8% vs 6%). Controlling for confounding variables, being discharged to a credentialed facility decreased SNF costs by $1961 and PAC costs by $3126 per patient.”

Dr. Courtney commented to OSN “We partnered with several SNFs in our area in order to align incentives to improve the quality of our care. We will preferentially send our patients to these internally credentialed SNFs, while they work to minimize their length of stay and communicate with our team regarding any potential complications. This can help us see patients in the office and prevent unnecessary ER visits and hospital readmissions as well.”

“If you are participating in a Medicare bundled payment model such as BPCI-Advanced or CJR, consider partnering and aligning incentives with a few SNFs in your area to care for your patients.  This can help provide better care for your patients, substantially reduce costs, and improve your practice’s performance in bundled payment models.”

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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