Ronald E Delanois1, Chukwuweike U Gwam1, Jeffrey J Cherian2, Jennifer I Etcheson1, Nicole E George1, Kathleen A Schneider3, Michael A Mont4. 1. Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Department of Orthopaedics, Sinai Hospital of Baltimore, Baltimore, MD. 2. Philadelphia College of Osteopathic Medicine, Department of Orthopaedics, Philadelphia, PA. 3. Berkley Research Group LLC, Hunt Valley, MD. 4. Department of Orthopaedic Surgery Cleveland Clinic, Cleveland, OH.
Abstract
BACKGROUND: The state of Maryland was granted a waiver by the Center for Medicare and Medicaid Services to implement a Global Budget Revenue (GBR) reimbursement model. This study aims to compare (1) costs of inpatient hospital stays; (2) postacute care costs; (3) lengths of stay (LOS); and (4) discharge disposition who underwent primary total hip arthroplasty at a single Maryland-based orthopedic institution before and after the implementation of GBR. METHODS: The Maryland Center for Medicare and Medicaid Services database was queried to obtain all Medicare patients who underwent total hip arthroplasty at a single institution before and after the implementation of GBR. We compared the differences in costs for the following: inpatient care, the postacute care period, and readmissions. In addition, we evaluated differences in LOS, discharge disposition, and complication rates. RESULTS: There was a significant decrease in inpatient costs ($26,575 vs $23,712), an increase in mean home health costs ($627 vs 1608), and a decrease in mean durable medical equipment costs ($604 vs $82) and LOS (2.92 days vs 2.33 days). There was an increase in discharge to home rates (72.3% vs 78.9%) and a decrease in discharge to acute rehabilitation (4.3% vs 1.8%) CONCLUSION: Under the GBR model, our institution experienced significant cost savings during the inpatient and postacute care episodes. Thus, GBR may serve as a viable solution to reducing costs to Medicare for high-volume arthroplasty institutions with a large Medicare population. Multicentered studies are needed to verify our results.
BACKGROUND: The state of Maryland was granted a waiver by the Center for Medicare and Medicaid Services to implement a Global Budget Revenue (GBR) reimbursement model. This study aims to compare (1) costs of inpatient hospital stays; (2) postacute care costs; (3) lengths of stay (LOS); and (4) discharge disposition who underwent primary total hip arthroplasty at a single Maryland-based orthopedic institution before and after the implementation of GBR. METHODS: The Maryland Center for Medicare and Medicaid Services database was queried to obtain all Medicare patients who underwent total hip arthroplasty at a single institution before and after the implementation of GBR. We compared the differences in costs for the following: inpatient care, the postacute care period, and readmissions. In addition, we evaluated differences in LOS, discharge disposition, and complication rates. RESULTS: There was a significant decrease in inpatient costs ($26,575 vs $23,712), an increase in mean home health costs ($627 vs 1608), and a decrease in mean durable medical equipment costs ($604 vs $82) and LOS (2.92 days vs 2.33 days). There was an increase in discharge to home rates (72.3% vs 78.9%) and a decrease in discharge to acute rehabilitation (4.3% vs 1.8%) CONCLUSION: Under the GBR model, our institution experienced significant cost savings during the inpatient and postacute care episodes. Thus, GBR may serve as a viable solution to reducing costs to Medicare for high-volume arthroplasty institutions with a large Medicare population. Multicentered studies are needed to verify our results.
Authors: Chukwuweike U Gwam; Kathleen B Urquico; Jennifer I Etcheson; Nicole E George; Carlos A Higuera Rueda; Ronald E Delanois Journal: Arthroplast Today Date: 2018-08-18
Authors: Haomiao Li; Yingchun Chen; Hongxia Gao; Jingjing Chang; Dai Su; Shihan Lei; Di Jiang; Xiaomei Hu; Min Tan; Zhifang Chen Journal: Int J Environ Res Public Health Date: 2019-05-03 Impact factor: 3.390
Authors: Iciar M Dávila Castrodad; Nequesha S Mohamed; Wayne A Wilkie; Ethan A Remily; Andrew N Pollak; Michael A Mont; Ronald E Delanois Journal: Arthroplast Today Date: 2020-01-09