Do Bundled Payments Cut Joint Replacement Costs?

ALL INCLUSIVE Medicare's bundled payment for joint replacements model began in 2009.

Medicare's bundled payment model can decrease the cost of total joint replacement surgery by 20% without sacrificing quality outcomes, according to new research published in JAMA Internal Medicine.

The assessment of 3,738 hip and knee replacements performed at 5 hospitals of the Baptist Health System (BHS) network in San Antonio, Texas, shows the average cost of the procedures and 30 days of post-op care decreased from $26,785 to $21,208 between 2008 and 2015. The savings were realized primarily through a 29% drop in the cost of implants and a 27% decrease in spending on post-op recovery care, according to the study.

Medicare reimbursed joint replacements based on the fee-for-service payment model at the beginning of the study period, but in January 2009 began the voluntary trial of the bundled payment model, which pays hospitals a single amount for surgery and 30 days of follow-up care. Hospitals paid under the bundled payment format are incentivized to reduce the cost of care, especially related to expensive recoveries in rehab facilities, in order to increase the gap between total expenses and Medicare's fixed reimbursement payments.

The findings demonstrate how bundled payments contribute to savings related to the costs of in-hospital surgical treatment and post-discharge recovery care, says study lead author Amol S. Navathe, MD, PhD, an assistant professor in the department of medical ethics and health policy at the University of Pennsylvania's Perelman School of Medicine in Philadelphia.

Says Dr. Navathe, "Policymakers should take note of the fact the results suggest hospitals may directly benefit in bundled payment models."

Daniel Cook

OSHA Seeking Input on Workplace Violence in Health Care

BAD MARKS Healthcare workers take far more days off due to violent assaults than other private-sector workers.


OSHA is looking for feedback on the extent and nature of workplace violence in health care, as well as the nature and effectiveness of interventions and controls that might be used to prevent it. Details on how to submit comments and materials are here. The deadline is April 6.

In a report issued last March, the Government Accountability Office (GAO) says that the rate of workplace violence against healthcare employees and those involved in social assistance services is substantially higher than the rate in other private industry. But the extent of the problem and its associated costs are unknown, it said, because healthcare workers may not always report such incidents, and limited research exists on the issue.

It is known that in 2013, the most recent year in which data was available, healthcare workers in inpatient facilities required an estimated 5 times as many days off due to workplace-violence-related injuries as did private-sector workers overall, according to the Department of Labor. The most common types of reported assaults, says the GAO, are hitting, kicking, and beating.

Jim Burger

In Pediatric Patients, Obesity and SSIs Go Hand in Hand

WEIGHTY MATTER Consider the relationship between obesity and SSIs when assessing pre-operative pediatric patients and their families.

Does obesity pose a significant health risk to surgical patients regardless of their age? It appears so. Although the correlation between obesity and surgical complications has been well documented in adults, a study published in the journal Surgical Infections suggests elevated body mass index in pediatric surgical patients increases the likelihood of developing surgical site infections.

In reviewing cases from more than 66,600 surgical patients ages 2 to 18, the authors of the study categorized each patient according to BMI: underweight, normal, overweight or obese. In the 1,380 patients who had SSIs — 767 male, 613 female — elevated BMI (overweight and obese) was shown to be a significant risk factor. Patients who had pediatric general surgery (3.6%) and cardiothoracic surgery (2.5%) reported the highest rates of SSIs. Also, the most common SSIs among overweight and obese patients were superficial incisional in nature.

The study's single-center review identified 115 patients with SSIs. Of these, nearly 30% were overweight or obese, with few other identifiable SSI risk factors. Here, appendectomy was the most common procedure associated with SSIs, and the subspecialties of pediatric surgery and pediatric orthopedics reported the highest rates of SSIs.

Healthcare providers should consider these potentially troubling statistics when assessing and counseling pre-operative pediatric patients and their families, the study's authors suggest.

Obesity has long been considered a risk factor for adults who are undergoing surgery. A 2011 study published in JAMA Surgery showed that obesity increases the risk of an SSI after colectomy by 60%. The study also illustrated how the presence of infection increased the cost of treatment by more than $17,300 per patient.

Bill Donahue

InstaPoll: Can Staff Carry Over Unused PTO Days From Year to Year?

Do you let staff carry over unused sick and vacation time from one year to the next? Tell us in this week's InstaPoll.

You're in the minority if you charge your surgeons a fee for credentialing. Only 9% of ASC respondents and 5% of hospital respondents to last week's poll of 250 surgical facility leaders do so. The results:

Do you charge your surgeons for credentialing?

  • yes (ASC) 9%
  • yes (hospital) 5%
  • no (ASC) 73%
  • no (hospital) 13%

Dan O'Connor

News & Notes

  • Overnight stays at Florida ASCs? Patients will be able to stay overnight — up to 24 hours — at ambulatory surgery centers in Florida, should a bill proposed last month by Senate Republican Greg Steube become law. The bill, SB222, also calls for the creation of a new kind of healthcare facility, the "recovery care center," where patients could stay for 72 hours after surgery. If approved when Florida Legislature begins its 2017 legislative session in March, the bill would take effect on July 1.
  • Joint Commission reverses rule on texting In an updated policy statement, the Joint Commission now says that using secure text messaging for patient care orders is unacceptable. Though data and privacy concerns have been addressed, it says, the "impact of secure text orders on patient safety remains unclear."
  • Colonoscopy sedation controversy Health Alliance Plan, a private insurer based in Detroit, Mich., says beginning March 1 it will longer reimburse for colonoscopies involving monitored anesthesia care with propofol. The state's surgery centers say using alternative sedatives that can't compare to the fast emergence afforded by propofol will limit the number of patients they can screen and could drive more cases to hospital outpatient departments, where care is more costly.