Despite the known increase of the cost of care when patients undergoing total knee arthroplasty are discharged to a skilled nursing facility, select facilities may disproportionately increase the cost of care compared with others, according to results published in The Journal of Arthroplasty.
Researchers identified 1,223 TKAs performed under bundled payment initiatives. Overall, 30.9% of patients were discharged to a skilled nursing facility. Of these patients, 246 patients selected one of the four most common skilled nursing facilities, according to results. Researchers investigated each of these four skilled nursing facilities for length of stay, cost of care and whether the overall target price for the episode of care was reached.
Results showed a 90-day episode of care had an average net payment of $24,353 with a mean 13.7 days spent under care at a skilled nursing facility. Although each skilled nursing facility represented a significant fiscal portion of the total episode of care, researchers noted a significantly longer length of stay and higher cost of care per day among patients released to skilled nursing facility D. This resulted in a greater total cost by an average of $7,461 per patient and no episode of care under the target price, according to results. However, researchers found no significant difference in the remainder of the episode of care cost across the four cohorts when the cost of the skilled nursing facility was removed. Multivariable linear regression model showed a significant association with higher cost of care among American Society of Anesthesiologists grade 3 or 4 and a skilled nursing facility.
“In light of this observed discrepancy, selective partnerships should be permitted by CMS and adopted by arthroplasty surgeons in order to effectively reduce the total cost of the [episode of care] EOC for Medicare beneficiaries,” the authors wrote. – by Casey Tingle
Disclosures: Ryan reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.