Risk Factors Associated With Health Care Utilization and Costs of Patients Undergoing Lower Extremity Joint Replacement

Meghan A Knoedler; Molly M Jeffery; Lindsey M Philpot; Sarah Meier; Jehad Almasri; Nilay D Shah; Bijan J Borah; M Hassan Murad; A Noelle Larson; Jon O Ebbert

doi:10.1016/j.mayocpiqo.2018.06.001

Risk Factors Associated With Health Care Utilization and Costs of Patients Undergoing Lower Extremity Joint Replacement

Mayo Clin Proc Innov Qual Outcomes. 2018 Jul 31;2(3):248-256. doi: 10.1016/j.mayocpiqo.2018.06.001. eCollection 2018 Sep.

Authors

Meghan A Knoedler¹, Molly M Jeffery^{1

2}, Lindsey M Philpot¹, Sarah Meier³, Jehad Almasri¹, Nilay D Shah^{1

2}, Bijan J Borah^{1

2}, M Hassan Murad¹, A Noelle Larson⁴, Jon O Ebbert¹

Affiliations

¹ Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
² Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
³ Manatt Health, Manatt, Phelps & Phillips LLP, Washington, DC.
⁴ Department of Orthopedic Surgery, Department of Medicine, Mayo Clinic, Rochester, MN.

Abstract

Background: The Comprehensive Care for Joint Replacement program implemented by the Centers for Medicare and Medicaid Services did not incorporate risk adjustment for lower extremity joint replacement (LEJR). Lack of adjustment places hospitals at financial risk and creates incentives for adverse patient selection.

Objective: To identify patient-level risk factors associated with health care utilization and costs of patients undergoing LEJR.

Methods: A comprehensive search of research databases from January 1, 1990, through January 31, 2016, was conducted. The databases included Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and SCOPUS and is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search identified 2020 studies. Eligible studies focused on primary unilateral and bilateral LEJR. Independent reviewers determined study eligibility and extracted utilization and cost data.

Results: Seventy-nine of 330 studies (24%) were included and were abstracted for analysis. Comorbidities, age, disease severity, and obesity were associated with increased costs. Increased number of comorbidities and age, presence of specific comorbidities, lower socioeconomic status, and female sex had evidence of increased length of stay. We found no significant association between indication for surgery and the likelihood of readmission.

Conclusion: Developing a risk adjustment model for LEJR that incorporates clinical variables may serve to reduce the likelihood of adverse patient selection and enhance appropriate reimbursement aligned with procedural complexity.

Keywords: ADL/IADL, activity of daily living/instrumental activity of daily living; APR-DRG, All Patient Refined Diagnosis Related Group; ASA, American Society of Anesthesiologists; BMI, body mass index; CJR, Comprehensive Care for Joint Replacement; CMS, Centers for Medicare and Medicaid Services; LEJR, lower extremity joint replacement; LOS, length of stay.