AAOS Best Paper Award Goes to NYU Langone Research Team

The best paper in all of orthopedics for practice management and/or rehabilitation, according to the American Academy of Orthopaedic Surgeons (AAOS), for 2024 came from a team of researchers at New York University’s Langone Orthopedics hospital.

The paper, “The Financial Burden of Patient Comorbidities on Total Knee Arthroplasty Procedures – A Matched Cohort Analysis of High-Comorbidity Burden to Non-High-Comorbidity Burden Patients,” looked into the reimbursement issues surrounding the treatment of total knee arthroplasty (TKA) patients with multiple comorbidities.

This study, which collected data from 10,647 patients (1,186 high-comorbidity patients and 9,461 non-high-comorbidity patients), found that high-comorbidity patients undergoing TKA incurred significantly higher total and direct costs compared to non-high-comorbidity patients patients—BUT without an increase in hospital revenue for high-comorbidity burden patients.

“Direct costs were 12.5% greater (95% CI, 8.8-16.2%) among high-comorbidity patients,” said Ran Schwarzkopf, M.D., senior author of the study and professor at NYU Langone Orthopedics, to OTW. “Similarly, total costs were 15.6% greater (95% CI, 11.6-19.5%) in this patient group as well.”

“And while no significant difference was found between groups with respect to hospital revenue (-1.5%; 95% CI, -80 to 4.9%), the cost differences between the two resulted in a significantly decreased contribution margin among high-risk patients (-19.9%; 95% CI, -34.9 to -4.9%).”

“Perhaps not surprisingly, more high-risk patients (15 vs 7) also experienced hospital readmission within the first 90 days after surgery.”

“Reasons for these readmissions included sepsis, surgical site infection, fracture, prosthetic join infection, dehiscence, hematoma, mechanical failure, pain, and non-surgical site orthopedic complications.”

“Hospital length of stay was also greater among those in the high-risk group (3.3 vs 2.7 days). On the other hand, no differences were found between groups with respect to operating room time or 90-day revision rates.”

OTW asked Dr. Schwarzkopf to opine on how reimbursement programs might adjust for patient comorbidity burdens. Dr. Schwarzkopf responded: “I think we need to define what comorbidity burden justifies the higher diagnosis-related group for inpatient status.”

“After seeing the decreased contribution margin in the high-risk patient group, we then tried to calculate the percentage of patients who would need to be classified in the higher acuity diagnosis-related group to at least keep the contribution margin equal.”

“We found that it was about 25%, which means that one-fourth of our patients have to get the higher diagnosis-related group for TKA to still be fiscally viable in these patients without a decrease in the contribution margin. Less than 4% of our patients got the higher paying diagnosis-related group in the study.”

“It will be important for hospitals to try to get diagnosis-related group 469 vs. 470 for these high comorbidity patients. We need to advocate, and we need to push for this, but we have to continue caring for these patients because, surgically, they do well.”

Dr. Schwarzkopf: “This imbalance in contribution margins poses a significant threat to the financial sustainability of healthcare institutions, impacting their ability to provide quality care to these vulnerable patient populations.”