Hospital Economics of Primary Total Knee Arthroplasty at a Teaching Hospital
Tóm tắt
The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.
Tài liệu tham khảo
Glaser D, Lotke P. Cost-effectiveness of immediate postoperative radiographs after uncomplicated total knee arthroplasty: a retrospective and prospective study of 750 patients. J Arthroplasty. 2000;15:475–478.
Healy WL, Finn D. The hospital cost and the cost of the implant for total knee arthroplasty: a comparison between 1983 and 1991 for one hospital. J Bone Joint Surg Am. 1994;76:801–806.
Healy WL, Iorio R. Implant selection and cost for total joint arthroplasty: conflict between surgeons and hospitals. Clin Orthop Relat Res. 2007; 457:57–63.
Healy WL, Iorio R, Ko J, Appleby D, Lemos DW. Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am. 2002;84:348–353.
Healy WL, Iorio R, Lemos MJ, Patch DA, Pfeifer BA, Smiley PM, Wilk RM. Single price/case price purchasing in orthopaedic surgery: experience at the Lahey Clinic. J Bone Joint Surg Am. 2000;82:607–612.
Healy WL, Iorio R, Richards JA, Lucchesi C. Opportunities for control of hospital costs for total joint arthroplasty after initial cost containment. J Arthroplasty. 1998;13:504–507.
Iorio R, Healy WL, Richards JA. Comparison of the hospital cost of primary and revision total knee arthroplasty after cost containment. Orthopedics. 1999;22:195–199.
Iorio R, Robb WJ, Healy WL, Berry DJ, Hozack WJ, Kyle RF, Lewallen DG, Trousdale RT, Jiranek WA, Stamos VP, Parsley BS. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008;90:1598–1605.
Jacoby J. Medicare and the Mayo Clinic. Boston Globe. January 6, 2010.
Kocher MS, Erens G, Thornhill TS, Ready JE. Cost and effectiveness of routine pathological examination of operative specimens obtained during primary total hip and knee replacement in patients with osteoarthritis. J Bone Joint Surg Am. 2000;82:1531–1535.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.
Lahey Clinic Finance. Total Joint Arthroplasty Margin Analysis, 2004. Burlington, MA: Lahey Clinic; 2004.
Lahey Clinic Finance. Total Joint Arthroplasty Margin Analysis, 2007. Burlington, MA: Lahey Clinic; 2007.
Lawrence T, Moskal JT, Diduch DR. Analysis of routine histological evaluation of tissues removed during primary hip and knee arthroplasty. J Bone Joint Surg Am. 1999;81:926–931.
Losira L, Walensky RP, Kessler CL, Emrani DS, Reichmann, WM, Wright EA, Solomn DH. Yelim Paltier AD, Katz JN. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med. 2009;169:1102–1103.
Mendenhall S. Hip and knee implants list prices rise 5.6%. Orthopaedic Network News. 2009;20:1–7.
Mendenhall S. Hospital resources and implant cost management—a 2008 update. Orthopaedic Network News. 2009;20:17.
Mendenhall S. 2010 CMS payment update. Orthopaedic Network News. 2009;20:22–23.
Moskal JT, Diduch DR. Postoperative radiographs after total knee arthroplasty: a cost-containment strategy. Am J Knee Surg. 1998;11:89–93.
Olmos D. Mayo Clinic in Arizona to stop treating some Medicare patients. December 31, 2009. Available at: www.bloomberg.com/apps/news?p…d=aHoYSI84VdL0. Accessed March 3, 2010.
Pagnano MW, Forero JH, Scuderi GR, Harwin SF. Is the routine examination of surgical specimens worthwhile in primary total knee arthroplasty? Clin Orthop Relat Res. 1998;356:79–84.
Schwarcz TH, Matthews MR, Hartford JM, Quick RC, Kwolek CJ, Minion DJ, Endean ED, Mentzer RM. Surveillance venous duplex is not clinically useful after total joint arthroplasty when effective deep venous thrombosis prophylaxis is used. Ann Vasc Surg. 2004;18:193–198.
US Department of Labor. Bureau of Labor Statistics. CPI inflation calculator. Available at: www.bls.gov/data/inflation_calculator.htm. Accessed March 3, 2010.
Ververeli PA, Masonis JL, Booth RE, Hozack WJ, Rothman RH. Radiographic cost reduction strategy in total joint arthroplasty: a prospective analysis. J Arthroplasty. 1996;11:277–280.
Yao L. Knee replacements are determined to be cost effective. Wall Street Journal. June 23, 2009.