Outcomes over 90-day Episodes of Care in Medicare Fee-for-Service Beneficiaries receiving Joint Replacement

• Published in: The Journal of arthroplasty 2017-03, Vol.32 (9), p.2639-2647.e1
• Main Authors: Middleton, Addie, PhD, DPT, Lin, Yu-Li, MS, Graham, James E., PhD, DC, Ottenbacher, Kenneth J., PhD, OTR
• Format: Article
• Language: English
• Subjects: Orthopedics
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.03.040

Abstract Background In an effort to improve quality and reduce costs, payments are being increasingly tied to value through alternative payment models, such as episode-based payments. The objective of this study was to better understand the pattern and variation in outcomes among Medicare beneficiaries receiving lower extremity joint replacement over 90-day episodes of care. Methods Observed rates of mortality, complications, and readmissions were calculated over 90-day episodes of care among Medicare fee-for-service beneficiaries who received elective knee replacement and elective or non-elective hip replacement procedures in 2013-2014 (N=640,021). Post-acute care utilization of skilled nursing and inpatient rehabilitation facilities was collected from Medicare files. Results Mortality rates over 90-days were 0.4% (knee replacement), 0.5% (elective hip replacement), and 13.4% (non-elective hip replacement). Complication rates were 2.1% (knee replacement), 3.0% (elective hip replacement), and 8.5% (non-elective hip replacement). Inpatient rehabilitation facility utilization rates were 6.0% (knee replacement), 6.7% (elective hip replacement), and 23.5% (non-elective hip replacement). Skilled nursing facility utilization rates were 33.9% (knee replacement), 33.4% (elective hip replacement), and 72.1% (non-elective hip replacement). Readmission rates were 6.3% (knee replacement), 7.0% (elective hip replacement), and 19.2% (non-elective hip replacement). Patients’ age and clinical characteristics yielded consistent patterns across all outcomes. Conclusions Outcomes in our national cohort of Medicare beneficiaries receiving lower extremity joint replacements varied across procedure types and patient characteristics. Future research examining trends in access to care, resource use, and care quality over bundled episodes will be important for addressing the challenges of value-based payment reform.