High-quality THA, TKA care may occur without being enrolled in a bundle payment model
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Published results showed high quality care for total hip arthroplasty may be maintained, while care for total knee arthroplasty may be improved with reduced complications and length of stay under a fee-for-service model.
“This study brings to light that the infrastructure built by the arthroplasty community as a result of bundled payments is strong as we continue to improve on low-cost, high-quality patient care, regardless of payment structure,” Peter A. Gold, MD, of Rothman Orthopaedic Institute, told Healio.
Gold and colleagues compared patient demographics, comorbidities, discharge disposition, complications and 90-day readmissions between patients who underwent TKA (n=1,203) and THA (n=1,088) from Oct. 1, 2018, to Aug. 2, 2019, during enrollment in the Bundled Payment for Care Improvement-Advanced (BPCI-A) model and patients who underwent TKA (n=2,737) and THA (n=2,009) from Jan. 1, 2020, to March 30, 2021, after withdraw from the BPCI-A. Researchers considered readmission and complications as the primary outcome measures of the study, while discharge disposition, length of stay and medical comorbidity profile were secondary outcomes. Researchers performed multivariate analysis to identify if bundled participation was associated with complications or readmissions.
Results showed patients in the post-bundle group who underwent TKA had significantly lower 90-day complication rates (2.4% vs. 3.7%) and fewer orthopedic-related complications compared with patients in the BPCI-A group (0.6% vs. 2%). While patients who underwent THA in the post-bundle period had similar length of stay vs. patients in the BPCI-A period, researchers noted length of stay continued to decrease for patients who underwent TKA in the post-bundle period compared with patients in the BPCI-A period.
Patients who underwent TKA or THA in the post-bundle period were less likely to be discharged to a rehabilitation facility, but were more likely to utilize home health resources, according to results.
After controlling for confounding patient demographics and comorbidities, researchers found patients who underwent TKA in the post-bundle period had a statistically significant lower risk of 90-day overall complications vs. patients in the BPCI-A period.
Patients with a history of congestive heart failure who underwent TKA had an increased risk for postoperative complications and patients with malignancy who underwent TKA had an increased risk for readmissions, according to results. Researchers noted patients with previously existing cerebrovascular disease who underwent TKA had an increased risk for readmission but not complication. After THA, results showed increasing age and patients with a history of diabetes or cerebrovascular disease had an increased risk for postoperative complications and readmissions, respectively.
“We hope moving forward that CMS and other payers will directly incentivize the arthroplasty community’s continued dedication to value in total joint replacement,” Gold said.
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