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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
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Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study
Alexander S McLawhorn1, William W Schairer1, Ran Schwarzkopf2
1Department of Orthopaedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York.
The Journal of Arthroplasty
|December 25, 2017
Summary
Conversion total hip arthroplasty (THA) leads to more complications and longer hospital stays than primary THA. Risk adjustment is needed for conversion THA reimbursement under new payment models.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Patient Outcomes
Background:
- Medicare reimbursement for hip arthroplasty uses fixed DRG codes.
- Current alternative payment models lack risk adjustment for care episodes.
- This study examines outcomes of primary vs. conversion total hip arthroplasty (THA).
Purpose of the Study:
- Compare outcomes of primary THA versus conversion THA.
- Evaluate the need for risk adjustment in conversion THA procedures.
- Inform reimbursement strategies in evolving payment models.
Main Methods:
- Utilized the National Surgical Quality Improvement Program database (2007-2014).
- Included primary and conversion THA cases, excluding hip fractures and cancer.
- Matched 2018 conversion THA patients with 2018 primary THA patients using propensity scores.
Main Results:
- Conversion THA had longer operative times, increased transfusions, and longer hospital stays.
- Conversion THA demonstrated higher odds of complications, deep infection, and death.
- No significant difference was found in readmission rates between the groups.
Conclusions:
- Conversion THA is associated with greater resource utilization and poorer outcomes compared to primary THA.
- Findings support the necessity of risk adjustment for conversion THA in bundled payment models.
- This research highlights disparities in outcomes that warrant consideration in healthcare reimbursement.
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