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Variation in Diagnoses for Hip Arthroplasty Among New York State Hospitals: Implications for the Comprehensive Care
John A Buza1, Jeffrey M Jancuska1, James D Slover1
1Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
Insights
High-volume hospitals perform more hip arthroplasty (HA) for osteoarthritis (OA) than fractures, potentially improving outcomes and costs. This variation in diagnosis impacts financial implications for HA care.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Healthcare Policy
Background:
- The Comprehensive Care for Joint Replacement model aims to reduce costs and enhance quality for Medicare joint arthroplasty patients.
- Hip arthroplasty (HA) costs differ based on preoperative diagnosis, with fractures being more expensive than osteoarthritis (OA).
- Hospitals with a higher proportion of HA for OA may benefit within the Comprehensive Care for Joint Replacement model.
Purpose of the Study:
- To analyze the variation in underlying diagnoses for HA across New York State hospitals.
- To identify hospital characteristics, such as patient volume, associated with diagnostic variations in HA.
Main Methods:
- Utilized the New York Statewide Planning and Research Cooperative System database for 127,206 primary HA procedures (2010-2014).
- Included data on underlying diagnoses, patient age, length of stay, and total charges.
- Categorized hospitals by volume and employed descriptive statistics for analysis.
Main Results:
- Osteoarthritis (OA) was the diagnosis for 74.2% of HA cases, significantly higher in high-volume (89.3%) and medium-volume (74.9%) hospitals versus low-volume (58.4%) hospitals.
- Hip arthroplasty (HA) for fractures was more prevalent in low-volume hospitals (32.4%) compared to medium-volume (18.0%) and high-volume (4.7%) hospitals (P < .05).
- Low-volume hospitals exhibited significantly longer lengths of stay across all diagnoses.
Conclusions:
- High-volume hospitals demonstrate a greater ratio of HA for OA versus fractures, suggesting potential advantages in patient outcomes and cost savings.
- The observed variation in preoperative diagnoses for HA has significant financial implications.
- Risk stratification of HA procedures based on preoperative diagnosis is crucial.
Background:
The Comprehensive Care for Joint Replacement model is designed to minimize costs and improve quality for Medicare patients undergoing joint arthroplasty. The cost of hip arthroplasty (HA) episode varies depending on the preoperative diagnosis and is greater for fracture than for osteoarthritis. Hospitals that perform a higher percentage of HA for OA may therefore have an advantage in the Comprehensive Care for Joint Replacement model. The purposes of this study are to (1) determine the variability in underlying diagnosis for HA in New York State hospitals, and (2) determine hospital characteristics, such as volume, associated with this.
Methods:
The New York Statewide Planning and Research Cooperative System database was used to identify 127,206 primary HA procedures from 2010 to 2014. The data included underlying diagnoses, age, length of stay, and total charges. Hospitals were categorized by volume and descriptive statistics were used.
Results:
OA was the underlying diagnosis for HA for 74.2% of all patients; this was significantly higher for high-volume (89.30%) and medium-volume (74.9%) hospitals than for low-volume hospitals (58.4%, P < .05). HA for fracture was significantly more common at low-volume hospitals (32.4%) compared to medium-volume (18.0%) and high-volume (4.7%) hospitals (P < .05). Length of stay was significantly greater at low-volume hospitals for all diagnoses.
Conclusion:
High-volume hospitals perform a higher ratio of HA cases for OA compared to fracture, which may lead to advantages in patient outcomes and cost. The variation in underlying diagnosis between hospitals has financial implications and underscores the need for HAs to be risk stratified by preoperative diagnosis.
