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Predicting the Incremental Hospital Cost of Adverse Events Among Medicare Beneficiaries in the Comprehensive Joint
Steven D Culler1, David S Jevsevar2, Kevin J McGuire3
1Rollins School of Public Health, Emory University, Atlanta, Georgia.
Insights
Preventing adverse events during lower extremity joint replacement (LEJR) surgery is crucial for managing costs in Medicare's Comprehensive Care for Joint Replacement (CJR) program. Costs for treating complications range from $6,308 to $29,061.
Area of Science:
- Healthcare economics
- Medical cost analysis
- Surgical outcomes research
Background:
- The Comprehensive Care for Joint Replacement (CJR) program financially burdens hospitals for Medicare beneficiaries' lower extremity joint replacement (LEJR) costs.
- Understanding the financial impact of adverse events is critical for managing risk within the CJR model.
Purpose of the Study:
- To quantify the incremental hospital costs associated with treating various adverse events following lower extremity joint replacement (LEJR).
- To inform cost-management strategies within the Comprehensive Care for Joint Replacement (CJR) program.
Main Methods:
- Utilized Medicare Provider Analysis and Review File data for fiscal year 2014.
- Identified 674,777 Medicare beneficiaries (MBs) undergoing LEJR procedures.
- Employed multivariable regression to estimate the cost of treating specific adverse events.
Main Results:
- The cost of treating adverse events varied significantly, ranging from $6,308 for pulmonary embolism to $29,061 for hip fracture with joint infection.
- Identified specific adverse events with higher associated treatment costs, such as hip fracture and periprosthetic joint infection.
Conclusions:
- Minimizing adverse events during LEJR hospitalizations is essential for controlling overall episode costs in the CJR program.
- The findings highlight the financial importance of patient safety and complication avoidance in joint replacement surgery under bundled payment models.
Background:
The Medicare program's Comprehensive Care for Joint Replacement (CJR) payment model places hospitals at financial risk for the treatment cost of Medicare beneficiaries (MBs) undergoing lower extremity joint replacement (LEJR).
Methods:
This study uses Medicare Provider Analysis and Review File and identified 674,777 MBs with LEJR procedure during fiscal year 2014. Adverse events (death, acute myocardial infarction, pneumonia, sepsis or shock, surgical site bleeding, pulmonary embolism, mechanical complications, and periprosthetic joint infection) were studied. Multivariable regressions were modeled to estimate the incremental hospital cost of treating each adverse event.
Results:
The risk-adjusted estimated hospital cost of treating adverse events varied from a high of $29,061 (MBs experiencing hip fracture and joint infection) to a low of $6308 (MBs without hip fracture that experienced pulmonary embolism).
Conclusion:
Avoidance of adverse events in the LEJR hospitalization will play an important role in managing episode hospital costs in the Comprehensive Care for Joint Replacement program.
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