Increased Orthopedic Specialization Lowers Costs and Improves Outcomes in Total Joint Arthroplasty

Total joint arthroplasty (TJA) volumes have risen in the past decade, resulting in increased national spending. Prior studies indicate that TJA performed at higher-volume hospitals result in better patient outcomes at lower costs. The purpose of this study is to determine whether increased orthopedic specialization has similar effects.

Centers for Medicare and Medicaid Services Inpatient Charge Data queries identified 2677 hospitals that performed TJA in 2015. Hospitals were assigned an orthopedic specialization ratio (OSR), defined as the ratio of musculoskeletal discharges to total discharges. Average covered charges (ACC), average total payments, and average Medicare payments (AMP) of TJA were extracted. TJA-specific, risk-adjusted complication and readmission scores were obtained from the Centers for Medicare and Medicaid Services Hospital Compare database. Comparisons between orthopedic specialty hospitals and nonspecialty hospitals performing TJA were made with Student t-tests. Regression models analyzed the relationship between OSR, volume and cost, payments, readmission rate score, and complication rate score.

Orthopedic specialty hospitals had lower ACC, average total payments, AMP, readmission, and complication scores than nonspecialty hospitals (all P < .001). Regression models showed that as the OSR increased from 0 to 1.0, ACC decreased by $19,242.83 and AMP decreased by $2310.75 (P < .001). Readmission score decreased by 0.349 and complication score decreased by 0.346 (P < .001) when controlling for volume as the OSR increased from 0 to 1.

Hospitals with increased OSR appear to perform TJA for Medicare patients at a lower cost with lower complication and readmission risk. It may be beneficial to consider the OSR when determining the ideal settings for TJA.