Hip Fracture Does Not Belong in the Elective Arthroplasty Bundle: Presentation, Outcomes, and Service Utilization Differ in Fracture Arthroplasty Care

• Published in: The Journal of arthroplasty 2018-07, Vol.33 (7), p.S56-S60
• Main Authors: Schroer, William C., Diesfeld, Paul J., LeMarr, Angela R., Morton, Diane J., Reedy, Mary E.
• Format: Article
• Language: English
• Subjects: CJR; hip fracture; Medicare; modifiable risk factors; payment bundle; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2018.02.091

Center for Medicare and Medicaid Services reimbursement is the same for hip arthroplasty performed electively for arthritis and urgently for femoral neck fracture. An analytic report of hip arthroplasty for a 5-hospital network identified 2362 cases performed from January 2014 to May 2016. Resource utilization was determined using 90-day charges. The fracture population (623 hips) was older (P < .01), had more medical comorbidities (28.3% vs 3.8%, P < .01), and was more likely to be anemic and malnourished (P < .01), and had longer hospital stay (5.7 vs 3.0 days, P < .0001), more frequent intensive care unit admission (4.5% vs 0.5%, P < .01), less frequent discharge to home (16.2% vs 83.6%, P < .01), more emergency department visits (26.5% vs 10.7%, P < .01), and more readmissions after hospital discharge (25.2% vs 12.2%, P < .01). Utilization of services ($50,875 vs $38,705, P < .0001) and the standard deviation of these services ($22,509 vs $9,847, P < .0001), from 90-day charges, were significantly greater in the fracture population. This study supports exclusion of fracture care from the Comprehensive Care for Joint Replacement bundled payment program.