Abstract
Background
Centers for Medicare and Medicaid Services removed total knee arthroplasties (TKAs)
from the Inpatient-Only list on January 1, 2018, which meant TKAs could be performed
on a hospital outpatient basis. We sought to understand (1) what the financial implications
have been for hospitals, (2) to what extent financial incentives have influenced the
adoption of outpatient TKAs across hospitals, (3) whether adoption of outpatient TKAs
has impacted the success of hospitals with managing post-acute care (PAC) spend, and
(4) the financial implications to Medicare of the adoption of outpatient TKAs.
Methods
We used national patient-level Medicare fee-for-service Part A claims data (100% sample)
from January 2018 through June 2019 to calculate the inpatient and outpatient TKA
payment rate for each hospital, and the distribution in these payments across the
country. We then ran case-level regressions to understand the factors associated with
adoption of outpatient TKAs, and the drivers of PAC spend. Finally, we quantified
the savings to Medicare.
Results
Hospitals on average received $3682 (30%) lower payment from Medicare for outpatient
TKA cases, but this varied widely across hospitals. The difference in payment rates
across hospitals was not statistically significantly related to their adoption rate
of outpatient TKAs. PAC spend was higher for same-day discharges, but lower for cases
that stayed at least 1 night. Based on the adoption rate of outpatient TKAs in Q2
2019, Medicare saved $355M on a run rate basis.
Conclusion
Hospitals have adopted outpatient TKAs independent of the financial impact. Medicare
has benefited from lower PAC spend and lower payments to hospitals.
Keywords
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References
- ([accessed 11.01.20])
- An examination of the adoption of outpatient total knee arthroplasty (TKA) since 2018.J Arthroplasty. 2020; : S24-S27
- The clinical and financial consequences of the Centers for Medicare and Medicaid Services’ two-midnight rule in total joint arthroplasty.J Arthroplasty. 2020; 35: 1-6.e1
- Unintended Bundled Payments for Care improvement consequences after removal of total knee arthroplasty from inpatient-only list.J Arthroplasty. 2019; 34: S121-S124
- Economic impact of outpatient medicare total knee arthroplasty at a tertiary care academic medical center.J Arthroplasty. 2020; : S37-S41
Article info
Publication history
Published online: February 03, 2020
Accepted:
January 27,
2020
Received:
January 23,
2020
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.01.074.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
