Race, Bundled Payment Policy, and Discharge Destination After TKA: The Experience of an Urban Academic Hospital.
Publication/Presentation Date
1-1-2018
Abstract
BACKGROUND: Total knee arthroplasty (TKA) provides good clinical outcomes for the treatment of end-stage osteoarthritis; however, discharge destination after TKA has major implications on postoperative adverse outcomes and readmissions. With the initiation of Bundled Payments for Care Improvement (BPCI), it is unclear how racial disparities in discharge destination after TKA will be affected by the new bundled payment for TKA.
METHODS: Bundled Payments for Care Improvement was implemented in July 01, 2014, at the University of Pennsylvania. We compared differences during early implementation (July 1, 2014, to, March 30, 2016) and during late policy implementation (April 1, 2016, to February 28, 2017) in patient characteristics (including race: African American [AA], white, and other race), discharge destination (skilled nursing facility [SNF], inpatient rehabilitation facility, home, home with home health, or other), and outcomes.
RESULTS: We identified 2276 patients who underwent TKA (43.8% AA, 48.2% white, and 8.0% other race). African American patients were more likely to be discharged to SNF as opposed to home than white patients both during the early BPCI (AA: 53.0%, n = 320; white: 32.4%, n = 210,
DISCUSSION: There were no significant differences in readmissions, length of stay, mortality, or intensive care unit days during early and late implementation of BPCI or when AA patients were compared to white patients.
CONCLUSION: We found no significant changes in racial variations in discharge destination and outcomes after elective TKA. Bundled Payments for Care Improvement has encouraged better preoperative preparation of patients and discharge planning; however, payment reforms alone might not be sufficient to address variation in post-op management following elective surgery.
Volume
9
First Page
2151459318803222
Last Page
2151459318803222
ISSN
2151-4585
Published In/Presented At
Fang, M., Hume, E., & Ibrahim, S. (2018). Race, Bundled Payment Policy, and Discharge Destination After TKA: The Experience of an Urban Academic Hospital. Geriatric orthopaedic surgery & rehabilitation, 9, 2151459318803222. https://doi.org/10.1177/2151459318803222
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
30370172
Department(s)
Administration and Leadership
Document Type
Article