VIDEO: Type of insurance may impact reimbursement in shoulder arthroplasty bundled payment
Click Here to Manage Email Alerts
SAN DIEGO — In this video, Paul Cagle, MD, discussed factors associated with cost and per case positive and negative adjusted contribution margins in bundled payment programs in total shoulder arthroplasty.
Among 314 total shoulder arthroplasties performed between January 2018 and September 2019, Cagle noted a mean per case hospitalization cost of approximately $27,949 and a length of stay of approximately 2.8 days. Results showed 47.8% of cases generated a negative adjusted contribution margin, which included 50.5% of Medicare patients, 72.6% of Medicare HMO patients and 100% of Medicaid patients. However, 5.2% of patients with private insurance had a negative adjusted contribution margin, according to Cagle. Researchers also found Medicare and Medicare HMO patients had an average negative adjusted contribution margin of 2.1 and 2.3 times greater than the average per case gain for cases that had a net positive adjusted contribution margin, respectively.
“We think this is important because we’re living in an era where we want to consider things like bundled payments, and if we’re going to successfully participate in a bundled payment plan, we need to make sure that we minimize institutional losses,” Cagle, associate professor of orthopedic, shoulder and elbow surgery at the Icahn School of Medicine at Mount Sinai, said of results presented at the American Academy of Orthopaedic Surgeons Annual Meeting. “This allows us to ensure that there’s going to be equitable access to care for all patients, regardless of their insurer or regardless of their financial situation.”
Collapse
Vervaecke A, et al. Paper 408. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. Aug. 31-Sept. 3, 2021; San Diego.
Click Here to Manage Email Alerts