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Managing total knee replacement under value-based payments
Richard J Snow, Robert Stone1, Khrista Achtermann
1Central Ohio Primary Care, 655 Africa Rd, Westerville, OH 43082-7923.
The American Journal of Managed Care
|May 25, 2023
Summary
A primary care group reduced knee replacement (KR) surgeries and institutional care by improving value-based care. This approach enhanced patient outcomes without increasing complications, showing promise for other specialties.
Area of Science:
- Health Services Research
- Orthopedic Surgery Outcomes
- Value-Based Healthcare
Background:
- Fee-for-service (FFS) models can lead to variations in healthcare utilization and outcomes.
- Primary care groups managing patients under financial risk face unique challenges and opportunities in specialty care coordination.
- Understanding opportunity gaps in knee replacement (KR) is crucial for improving care delivery.
Purpose of the Study:
- To evaluate opportunity gaps in knee replacement (KR) surgery.
- To set outcome goals for a primary care group managing patients under financial risk compared to FFS orthopedic groups.
- To assess the impact of an intervention on KR utilization and postacute care.
Main Methods:
- Cross-sectional opportunity gap analysis using risk-adjusted Medicare data.
- Historical cohort comparison to evaluate intervention impact on outcomes.
- Defined opportunity gaps in KR density, site of surgery, postacute care placement, and complications.
Main Results:
- Significant regional variations observed in KR density (2-fold), outpatient surgery rates (3-fold), and institutional postacute care (2.5-fold).
- The primary care group reduced KR density (15.5 to 13.0 per 1000), increased outpatient surgery (31% to 81.6%), and decreased institutional postacute care (16% to 6.1%) between 2019 and 2021.
- Complication rates remained stable with observed/expected ratios of 0.61 (2019) and 0.63 (2021).
Conclusions:
- Aligning incentives with performance goals and value-based partnerships improved KR care value without harm.
- The demonstrated improvements in knee replacement care are translatable to other specialty areas and markets.
- Performance information and goal setting can effectively reduce healthcare utilization and improve patient value.
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