Risk Adjustment for Medicare Total Knee Arthroplasty Bundled Payments
| Autor: | Peter B. Derman, Michael M. Kheir, Adrianne E. Soo, R. Carter Clement, L. Scott Levin, Lee A. Fleisher, David N. Flynn |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Joint replacement medicine.medical_treatment Total knee arthroplasty Medicare Reimbursement Mechanisms 03 medical and health sciences 0302 clinical medicine Postoperative Complications medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Arthroplasty Replacement Arthroplasty Replacement Knee Aged Aged 80 and over 030222 orthopedics Inpatient care business.industry Bundled payments Risk adjustment United States Incentive Orthopedic surgery Emergency medicine Costs and Cost Analysis Regression Analysis Surgery Female Risk Adjustment Health Expenditures business Body mass index |
| Zdroj: | Orthopedics. 39(5) |
| ISSN: | 1938-2367 |
| Popis: | The use of bundled payments is growing because of their potential to align providers and hospitals on the goal of cost reduction. However, such gain sharing could incentivize providers to “cherry-pick” more profitable patients. Risk adjustment can prevent this unintended consequence, yet most bundling programs include minimal adjustment techniques. This study was conducted to determine how bundled payments for total knee arthroplasty (TKA) should be adjusted for risk. The authors collected financial data for all Medicare patients (age≥65 years) undergoing primary unilateral TKA at an academic center over a period of 2 years (n=941). Multivariate regression was performed to assess the effect of patient factors on the costs of acute inpatient care, including unplanned 30-day readmissions. This analysis mirrors a bundling model used in the Medicare Bundled Payments for Care Improvement initiative. Increased age, American Society of Anesthesiologists (ASA) class, and the presence of a Medicare Major Complications/Comorbid Conditions (MCC) modifier (typically representing major complications) were associated with increased costs (regression coefficients, $57 per year; $729 per ASA class beyond I; and $3122 for patients meeting MCC criteria; P =.003, P =.001, and P Orthopedics. 2016; 39(5):e911–e916.] |
| Databáze: | OpenAIRE |
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