Study: Hospitals vary in adverse outcome rates for joint replacement
Adverse outcomes associated with hip or knee replacement surgery were less likely to occur among patients treated at hospitals that were performing a large number of these procedures from 2000 to 2012, according to new research published by the Journal of Bone and Joint Surgery.
The adverse outcome rate at the highest scoring hospitals (those in the top 10%) averaged 6%, compared with 20% at the worst scoring hospitals (those in the bottom 10%).
In the new bundle payment reimbursement system, which creates financial incentives for physicians to encourage better health outcomes, those for joint replacements reduced Medicare spending by 20% per episode in a recent JAMA Internal Medicine study.
There is significant risk for complications or readmission associated with joint replacement depending on where the procedure was performed, the researchers concluded after their analysis of Medicare data on more than 250,000 hip replacements and more than 670,000 knee replacements.
The worst performing hospitals shared some common characteristics, according to researchers. For instance, the worst performing hospitals were more likely to administer narcotics, which increased risk for falls and for health conditions like pneumonia, constipation, and nausea.
With the federal government's recent overhaul of the physician payment system, there is an increased focused on preventing adverse outcomes. In the payment models (Advanced Alternative Payments Models (APMs) and the Merit-based Incentive Payment System (MIPS) implemented by MACRA last year, Medicare reimbursement for physicians and other clinicians reflect performance metrics based on patient outcomes.
APMs may included bundled payments, which also take into account the cost of care for particular episodes.
The country's healthcare system is also moving toward population health management to achieve better preventive care, among other goals. “The majority of adverse outcomes and controllable expenses of total joint replacement occur after discharge from the hospital," lead author Dr. Donald Fry of MPA Healthcare Solution told Healthcare Dive via email. "Hospitals have to know their outcomes to effectively manage outcomes and costs in prospective payment models and incentive programs that will reward best performing providers."
- The Journal of Bone & Joint Surgery Risk-Adjusted Hospital Outcomes in Medicare Total Joint Replacement Surgical Procedures
- Healthcare Dive CMS joint bundle payments shoring up savings, researchers find