In today’s healthcare environment, hospital readmission rates are garnering an increasing amount of attention as the industry moves toward bundled payments, making it harder for providers to recoup reimbursement. This could present significant problems for orthopedic surgeons who perform total joint arthroplasties — one of the most commonly performed orthopedic procedures.
But, until now, there’s been no benchmark for what an acceptable rate should be for these procedures. The general belief, though, is lower readmission rates can improve care standards and lower costs. To answer the question about what acceptable readmission rates are for total joint arthroplasties (TJA), Prem N. Ramkumar, M.D., a resident physician of orthopedic surgery at the Cleveland Clinic, led a systemic review and meta-analysis of existing studies, looking for the average 30-day and 90-day readmission rates. The review was published in the September 2015 issue of the American Journal of Orthopedics.
By analyzing 12 total hip arthroplasty and 10 total knee arthroplasty studies, the team reviewed readmission rates for nearly 4 million patients for both time intervals. According to results, the gold standard for hip readmissions was 5.6 percent of the 30-day population and 7.7 percent of the 90-day group. Of the knee readmissions, the benchmark was 3.3 percent of 30-day readmissions and 9.7 percent of 90-day patients.
The cost of these readmissions is already an issue, Dr. Ramkumar said, but the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is ramping up and will push more and more providers into merit-based incentive payment systems. To better understand why these readmission rates are important and what you can do to improve your outcomes, Rheumatology Network spoke with Dr. Ramkumar about his study results and what they mean in the MACRA environment.
Rheumatology Network: Why did you decide to look into unplanned readmissions for total joint arthroplasty?
Dr. Ramkumar: Mainly, it was a timeliness issue. With the way reimbursement is being changed for the orthopedic surgeon, I think outcomes were being held against things we usually didn’t measure in the past. Before, how a physician would say whether an outcome was good was essentially based on what the surgeon said. Sometimes, the patient may or may not have agreed, but now there are other eyes on patient care. Now, the doctor-patient relationship isn’t just between those two. For me, it’s really being part of a larger team of players in the hospital and the belief that the readmission rates were timely because it’s one of the few metrics surgeons are being evaluated against.
Why Readmission Rates Matter
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Ramkumar PN, Chu CT, Harris JD, Athiviraham A, Harrington MA, White DL, Berger DH, Naik AD, Li LT. “Causes and Rates of Unplanned Readmissions After Elective Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.” American Journal of Orthopedics. (Belle Mead NJ). 2015 Sep;44(9):397-405.