Rothman Orthopaedics: How joint replacements are faring outside of Medicare program


Despite early success in Medicare's Bundled Payments for Care Improvement-Advanced program for total hip and knee replacement, Rothman Orthopaedic Institute withdrew from the initiative because of concerns around target price methodology and financial penalties.

Researchers from the Philadelphia-based group launched a study to determine if exiting the program led to a drop in the quality of care. The study is featured in the July 2022 edition of The Journal of Arthroplasty.

Four notes:

1. Researchers compared 2,737 primary total knee replacement and 2,009 primary total hip replacement cases from Jan. 1, 2020, to March 30, 2021, after Rothman's withdrawal from BPCI-A) to 1,203 total knee replacement and 1,088 total hip replacement cases from Oct. 1, 2018, to Aug. 2, 2019, in BPCI-A. 

2. Patient demographics, comorbidities, discharge disposition, complications and 90-day readmissions were examined. Multivariate analysis was performed to determine if bundle participation was associated with complications or readmissions.

3. Three study findings:

- Post-bundle total knee replacement patients had a shorter length of stay (1.4 days vs. 1.8 days).
- Both total knee replacement (5.6 percent vs. 19.2 percent) and total hip replacement (6 percent vs. 10 percent) patients were significantly less likely to be discharged to a rehabilitation facility.
- Post-bundle total knee replacement patients had lower complications but saw no difference in 90-day readmission.

4. The study found Rothman has maintained high-quality total hip replacement care and reduced complications and length of stay in total knee replacement under the fee-for-service model. Researchers advised CMS to partner with high-performing orthopedic practices to develop new models for risk sharing.

Read more about the study here.

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