STUDY: No Way to Predict Risk in Joint Replacements |

STUDY: No Way to Predict Risk in Joint Replacements

Study: No Way to Predict Risk in Joint Replacements (Orthopedics This Week)

One of the reasons for the study, as stated in the January 25, 2017 news release, is the new outcome based reimbursement environment. “To compel hospitals to do better, the Centers for Medicare and Medicaid Services (CMS) launched the Comprehensive Care for Joint Replacement (CJR) program in April 2016, which penalizes hospitals for readmission of joint replacement patients within 90 days.”

“In the absence of that risk adjustment, when sick patients have worse outcomes, hospitals will be penalized,” said Dr. Kumar. “If we could find an index that was working for this population, we could recommend that—but unfortunately none of them are working very well.”

Again, quoting directly from the press announcement; “Dr. Kumar and former colleagues at the University of Texas Medical Branch tested the applicability of the three industry-leading indices for predicting mortality and health care utilization: the Charlson Comorbidity Index, the Elixhauser Comorbidity Index and CMS’s Hierarchical Condition Category.”

“Dr. Kumar analyzed Medicare data on every beneficiary who survived for 90 days after a total knee or total hip replacement performed because of osteoarthritis between January 2009 and September 2011. In all, the study covered a total of 605,417 patients. The data showed that 46.3% of patients were discharged home, 40.9% went to skilled nursing facilities and 12.7% stayed in inpatient rehabilitation.”

Amit Kumar told OTW, “Studies have shown that poor functional status is strongly associated with increased used of post-acute care services and hospital readmission. Current risk adjustment models contain extensive information on medical diagnoses, but not function-related measures. The missing information on physical functional status in claims data of older hospitalized patients can affect the decision-making process on discharge destination and continuity of care.”

“Orthopedic surgeons may improve service delivery by developing appropriate risk adjustment model and care transition plans based on patient functional status and initiating an intervention to prevent specific comorbid conditions associated with greater risk of readmission. The preventive measure can be initiated before and after surgery to address the medical needs of patients with high-risk of readmission.

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