Should reimbursements for high-BMI total joint patients be adjusted?
Researchers from Canada have examined the costs and outcomes of total hip arthroplasty (THA) among patients in different weight categories and concluded that physician pay should be tied to the costs and efforts required to treat overweight patients.
Their work, “Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Hip Arthroplasty Patients of Varying Body Mass Index Levels,” appears in the November 24, 2018 edition of The Journal of Arthoplasty.
Edward Vasarhelyi, M.D., M.Sc. with the University of Western Ontario in Canada and co-author on the study, explained his purpose for the study to OTW, “This work was the first time we have been able to quantify our costs associated with treating patients of varying BMI [body mass index] levels.”
“By elucidating the absolute costs, as well as the cost drivers, we can better advocate for appropriate risk-adjusted remuneration for centres that provide care for the morbidly-obese and super-obese patients. We have shown that although they have significantly higher costs and complication rate, these patients derive equivalent clinical improvements in function and quality of life. Therefore, setting surgical BMI cutoffs above which patients are denied the possibility of a total hip arthroplasty is not justifiable.”
“It is widely understood that morbid obesity increases the technical difficulty in performing surgery and has an increased complication rate. What is lost in the debate is that clinically these patients still do very well, and in many cases their postoperative improvement, or change score, exceeds those of normal weight individuals.”
“Morbidly obese patients do have a higher relative risk of complications, but we are not accurate at predicting those patients who will experience them. Therefore, if we establish cutoffs beyond which surgery will not be offered, we exclude a large percentage of the population from a procedure we know they derive significant benefit from.”
“As well, much discussion occurs around weight loss, however, it is unclear that reductions in weight will actually change the risk profile of these patients and is debatable whether a patient’s weight is actually a modifiable risk factor or not.”
“The primary findings were that morbidly-obese and super-obese patients incur greater costs during the first 90-days than the non-obese cohort. These two cohorts have higher readmission and reoperation rates than normal BMI patients. Importantly, all BMI cohorts have clinically significant improvements in function that are comparable to the non-obese cohort.”
“Based on this, we feel that there should be risk-adjusted compensation for centres operating on higher BMI patients and that preoperative counselling of morbidly-obese and super-obese patients is warranted, but arbitrary restrictions should not be used to deny arthroplasty access since these patients have no effective alternatives and demonstrate equivalent progress to patients in lower BMI levels and have clinically significant functional improvements.”