What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

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• 作者：James D. Slover ; MD ; MS^a ; ; Kathleen A. Mullaly ; MSN^a ; Ashley Payne ; MSc^b ; Richard Iorio ; MD^a ; Joseph Bosco ; MD^a
• 关键词：total joint arthroplasty ; discharge disposition ; bundled payment ; cost-effectiveness ; length of stay
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：31
• 期：12
• 页码：2710-2713
• 全文大小：515 K

文摘

The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies.

absSec_2">Methods

abspara0015">We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility.

absSec_3">Results

abspara0020">The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted.

absSec_4">Conclusion

abspara0025">The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy.