Cost Study of 79,843 TKA Patients Has Good News

A team from Rush University in Chicago and the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, Pennsylvania, collected data from nearly 80,000 total knee arthroplasty (TKA) patients to determine the extent to which costs of treatment have changed since 2007. Their study, “National Trends in Post-Acute Care Costs Following Total Knee Arthroplasty From 2007 to 2016,” appears in the July 1, 2021 edition of The Journal of Arthroplasty.

Co-author Craig J. Della Valle, M.D., chief of Adult Reconstruction at Midwest Orthopaedics at Rush in Chicago, explained to OTW the new territory his study covered, “I think costs as a whole have been looked at previously, but I don’t think prior work has focused on the time period after discharge, where I think we know a lot of money is spent.”

So, to “follow the money,” the researchers collected cost data from a consecutive series of 79,843 primary TKA patients from the Humana claims dataset from 2007 to 2016. They defined post-acute care costs as claims within 90 days of surgery for subacute or inpatient rehabilitation, home health, outpatient or emergency visits, prescription medications, physical therapy, and readmissions.

The result? Costs have declined. Specifically, between 2007 and 2016, the average episode-of-care costs fell from $46,754 to $31,856 and post-acute care costs per patient decreased over the same time period from $20,224 to $13,498.

Furthermore, the rates of discharge to skilled nursing facilities, which were 25.0% in 2007, fell to 22.5% in 2016. Inpatient rehabilitation participation rates dropped off the cliff, going from 12.4% in 2007 to 2.1% in 2016. Readmissions decreased from 8.1% to 7.1% and the per patient savings amounted to $324.

As for the pattern of cost decline, the research team noted that total costs declined most rapidly after 2013 primarily due to a $3,516 (21%) decrease in post-acute spending.”

“I think the most important results are that orthopaedic surgeons have worked hard to spend wisely and reduce costs for the health care system,” said Dr. Della Valle to OTW.

“By limiting the number of patients who go to a secondary facility after discharge from the hospital, the health care system has saved massively. This was not and is not easy to do; many patients feel the need to go to one of these facilities and surgeons and their staff spend quite a bit of time educating patients on the value of these stays.”

“This also shifts more work and responsibility to the surgeon and the surgeon’s staff in the early postoperative period to be there to support the patient and ensure things are going smoothly. Further, surgeons have worked on a number of fronts, such as patient optimization, to reduce the risk of readmissions which have also saved the system substantial amounts of money.”

“I think this work suggests that the time and effort spent by orthopaedic surgeons to educate and optimize patients preoperatively has ‘paid off’ and that these efforts have real tangible benefits to both improve quality of care and decrease costs which is the definition of bringing value to the system.”