Can an arthroplasty risk score predict bundled care events after total joint arthroplasty?

Blair S. Ashley, MD; Paul Maxwell Courtney, MD, MS; Daniel J. Gittings, MD; Jenna A. Bernstein, MD; Gwo Chin Lee, MD; Eric L. Hume, MD; Atul F. Kamath, MD

Arthroplasty Today (Mar 2018)

Can an arthroplasty risk score predict bundled care events after total joint arthroplasty?

Blair S. Ashley, MD,
Paul Maxwell Courtney, MD, MS,
Daniel J. Gittings, MD,
Jenna A. Bernstein, MD,
Gwo Chin Lee, MD,
Eric L. Hume, MD,
Atul F. Kamath, MD

Affiliations

Blair S. Ashley, MD: Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA; Corresponding author: 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA. Tel.: +1 267 324 7484.
Paul Maxwell Courtney, MD, MS: Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA; Department of Orthopaedic Surgery, Rush University, Rush University Medical Center, Chicago, IL, USA
Daniel J. Gittings, MD: Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA
Jenna A. Bernstein, MD: Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA
Gwo Chin Lee, MD: Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA
Eric L. Hume, MD: Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA
Atul F. Kamath, MD: Department of Orthopaedic Surgery, University of Pennsylvania, Penn Musculoskeletal Center, Philadelphia, PA, USA

Journal volume & issue: Vol. 4, no. 1
pp. 103 – 106

Abstract

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Background: The validated Arthroplasty Risk Score (ARS) predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS), discharge disposition, and episode-of-care cost (EOCC). Methods: We retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation. Results: ARS implementation was associated with fewer patients going to a skilled nursing or rehabilitation facility after discharge (63% vs 74%, P = .002). There was no difference in LOS, EOCC, readmission rates, or complications. While the adoption of the ARS did not change the mean EOCC, ARS >3 was predictive of high EOCC outlier (odds ratio 2.65, 95% confidence interval 1.40-5.01, P = .003). Increased ARS correlated with increased EOCC (P = .003). Conclusions: Implementation of the ARS was associated with increased disposition to home. It was predictive of high EOCC and should be considered in risk adjustment variables in alternative payment models. Keywords: Bundled payments, Risk stratification, Arthroplasty

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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