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Managing total knee replacement under value-based payments.

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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.

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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.