Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the...

Area of Science:

• Healthcare Economics
• Orthopedic Surgery
• Health Services Research

Background:

• Bundled Payments for Care Improvement (BPCI) initiative aims to reduce total joint arthroplasty costs.
• BPCI covers all patient care from admission through 90 days post-discharge, including skilled nursing facilities (SNFs).
• The study investigates if hospital-SNF partnerships impact post-discharge costs.

Purpose of the Study:

• To determine if forming partnerships between hospitals and SNFs lowers post-discharge costs for total joint arthroplasty patients.
• To test the hypothesis that institutionally aligned SNFs incur lower post-discharge costs than non-aligned SNFs.

Main Methods:

• Analysis of 615 elective primary total hip and knee arthroplasty patients discharged to SNFs under BPCI (2014-2016).
• Patients categorized into three SNF alignment groups: non-partners, agreement-based partners, and institution-owned partners.
• Comparison of demographics, comorbidities, SNF length of stay (LOS), and 90-day costs across the three groups.

Main Results:

• Institution-owned partner SNFs (group 3) had the shortest mean hospital LOS (2.7 days) compared to non-partners and agreement-based partners (3.5 days).
• SNF LOS was significantly shorter in group 3 (11 days) versus group 2 (19 days) and group 1 (21 days).
• Total SNF costs and total 90-day costs were significantly lower in institution-owned partner SNFs (group 3) compared to the other groups, even after controlling for comorbidities.

Conclusions:

• Institution-owned SNF partnerships result in the shortest patient length of stay.
• These partnerships achieve the lowest SNF and total 90-day costs.
• Institution-owned SNFs provide these cost savings without increasing readmission risk.