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The economic significance of orthopaedic infections
Abstract:
Musculoskeletal infections are a leading cause of patient morbidity and rising healthcare expenditures. The incidence of musculoskeletal infections, including soft-tissue infections, periprosthetic joint infection, and osteomyelitis, is increasing. Cases involving both drug-resistant bacterial strains and periprosthetic joint infection in total hip and total knee arthroplasty are particularly costly and represent a growing economic burden for the American healthcare system. With the institution of the Affordable Care Act, there has been an increasing drive in the United States toward rewarding healthcare organizations for their quality of care, bundling episodes of care, and capitating approaches to managing populations. In current reimbursement models, complications following the index event, including infection, are not typically reimbursed, placing the burden of caring for infections on the physician, hospital, or accountable care organization. Without the ability to risk-stratify patient outcomes based on patient comorbidities that are associated with a higher incidence of musculoskeletal infection, healthcare organizations are disincentivized to care for moderate- to high-risk patients. Reducing the cost of treating musculoskeletal infection also depends on incentivizing innovations in infection prevention.
Insights
Musculoskeletal infections, including periprosthetic joint infections, are increasing and costly. Current healthcare reimbursement models do not incentivize treating high-risk patients, hindering infection prevention and cost reduction.
Area of Science:
- Orthopedics
- Infectious Diseases
- Health Economics
Background:
- Musculoskeletal infections (MSIs) are a significant cause of patient morbidity and escalating healthcare costs.
- The incidence of MSIs, encompassing soft-tissue infections, periprosthetic joint infections (PJIs), and osteomyelitis, is on the rise.
- Drug-resistant bacteria and PJIs in total hip and knee arthroplasty contribute substantially to the economic burden on the US healthcare system.
Purpose of the Study:
- To analyze the economic impact of musculoskeletal infections within the current US healthcare reimbursement landscape.
- To identify barriers to effective management and prevention of MSIs, particularly in high-risk patient populations.
- To explore the need for revised reimbursement models that incentivize quality care and innovation in infection control.
Main Methods:
- Review of current healthcare reimbursement policies, including the Affordable Care Act's impact on bundled payments and population management.
- Analysis of the financial implications of treating complex MSIs, especially those involving drug-resistant organisms and prosthetic joint infections.
- Examination of the disincentives within existing models for healthcare organizations to manage patients with comorbidities associated with higher MSI risk.
Main Results:
- Current reimbursement models often do not cover complications like infections, shifting the financial burden to providers.
- Lack of risk-stratification tools for patient outcomes based on comorbidities discourages care for moderate-to-high-risk patients.
- The current system disincentivizes investment in innovations for MSI prevention and treatment.
Conclusions:
- Reimbursement reform is crucial to address the growing economic and clinical burden of musculoskeletal infections.
- Incentivizing healthcare organizations to manage high-risk patients and invest in infection prevention innovations is essential.
- Aligning financial incentives with quality outcomes is necessary to reduce morbidity and healthcare expenditures associated with MSIs.
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