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High-Quality Skilled Nursing Facilities Are Associated With Decreased Episode-of-Care Costs Following Total Hip and Knee Arthroplasty.
Yayac, Michael; Pivec, Robert; Abbas, Asad; Vannello, Chris; Courtney, P Maxwell.
Afiliação
  • Yayac M; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
  • Pivec R; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
  • Abbas A; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
  • Vannello C; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
  • Courtney PM; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty ; 35(7): 1756-1760, 2020 07.
Article em En | MEDLINE | ID: mdl-32173616
BACKGROUND: With the increasing popularity of alternative payment models following total hip (THA) and knee arthroplasty (TKA), efforts have focused on reducing post-acute care (PAC) costs, particularly patients discharged to skilled nursing facilities (SNFs). The purpose of this study is to determine if preferentially discharging patients to high-quality SNFs can reduce bundled payment costs for primary THA and TKA. METHODS: At our institution, a quality improvement initiative for SNFs was implemented at the start of 2017, preferentially discharging patients to internally credentialed facilities, designated by several quality measures. 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. RESULTS: 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, P < .0001), PAC costs ($18,952 vs $15,148, P < .0001), and episode-of-care costs ($34,557 vs $30,831, P < .0001), with no difference in readmissions (10% vs 12%, P = .33) or complications (8% vs 6%, P = .15). Controlling for confounding variables, being discharged to a credentialed facility decreased SNF costs by $1961 (P = .0020) and PAC costs by $3126 (P = .0031) per patient. CONCLUSION: Quality improvement efforts through partnership with selective SNFs can significantly decrease PAC costs for patients undergoing primary THA and TKA.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artroplastia de Quadril / Artroplastia do Joelho Tipo de estudo: Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: J Arthroplasty Assunto da revista: ORTOPEDIA Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artroplastia de Quadril / Artroplastia do Joelho Tipo de estudo: Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: J Arthroplasty Assunto da revista: ORTOPEDIA Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos