Preoperative Education for Total Joint Arthroplasty: Does Reimbursement Reduction Threaten Improved Outcomes?
| Autor: | Steffanie S. Dolle, James H. MacDonald, Paul J. King, Jeanne D. Angeles, Grayson C. Kelmer, Justin Turcotte |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Joint arthroplasty Arthroplasty Replacement Hip Skilled Nursing Medicare 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee Reimbursement Aged Retrospective Studies Skilled Nursing Facilities 030222 orthopedics business.industry Attendance Length of Stay Patient Discharge United States Emergency medicine Skilled Nursing Facility business Nurse navigator Healthcare system Patient education |
| Zdroj: | The Journal of Arthroplasty. 36:2651-2657 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2021.03.016 |
| Popis: | Background Nurse navigation programs have been previously shown to reduce cost and improve outcomes after total joint arthroplasty (TJA). Medicare has proposed a 13.7% reduction in professional fee reimbursement for TJA procedures that may adversely impact providers’ and health systems’ ability to fund ancillary support resources such as nurse navigators. Methods A consecutive series of primary TJAs performed between April 2019 and February 2020 was retrospectively reviewed. Clinical and financial outcomes of patients attending a nurse navigator–led preoperative education class were compared with those who did not attend. Results There were 2057 TJAs identified during the study period. Most patients attended the preoperative education class (82.7%) and were discharged home (92.8%). Controlling for significant differences between groups, class attendance was associated with reduced length of stay (LOS), increased chance of 0- or 1-day LOS, reduced chance of discharge to a skilled nursing facility, and reduced hospital charges. For this patient sample, a proposed 13.7% reduction in nurse navigator–led classes was modeled to increase overall cost to payers by >$400,000 annually. Complete elimination of this class was estimated to increase the total annual cost by >$5,700,000 and cost per TJA by >$2700. Conclusion The use of a nurse navigator–led preoperative education class was associated with shorter LOS, more frequent 0- and 1-day LOS, reduced discharge to skilled nursing facilities, and lower total hospital charges for those patients who attended. Potential reductions proposed by Medicare may interfere with the ability to support such services and negatively impact both clinical and financial outcomes. |
| Databáze: | OpenAIRE |
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