Improvement in Total Joint Replacement Quality Metrics Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative
Improvement in Total Joint Replacement Quality Metrics Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative
复制标题
DOI：
10.2106/jbjs.16.00523
复制
发表时间：
2016-12-07
影响因子：
5.3
通讯作者：
Iorio, Richard
中科院分区：
文献类型：
--
作者：
Dundon, John M.;Bosco, Joseph;Iorio, Richard
背景资料：2013年1月，一家大型的三级城市学术医疗中心开始参与Bundled Payments for Care Improvement（BPCI）全关节置换术计划，该计划由医疗保险和医疗补助服务中心（CMS）于2011年实施。纳入了医疗保险严重性诊断相关组（MS-DRG）469和470。我们参与了BPCI模型2，其中一次护理包括出院后90天内的住院和所有急性期后护理费用。这一举措的目标是提高病人的护理和质量，通过以病人为中心的方法，通过支付innovation.Methods支持增加护理协调：住院时间（LOS），再入院，出院处置，和每集护理费用进行了分析，为3年相比，第1年的倡议。第一年后实施了多个计划，以改善绩效指标：外科医生指导的术前风险因素优化计划，加强护理协调和家庭服务，将静脉血栓栓塞性疾病（VTED）预防改为风险分层方案，感染预防措施，继续强调出院回家而不是住院，结果：在第1年和第3年分别有721例和785例初次全关节置换术患者，并对他们的数据进行了比较。平均住院时间从3.58天下降到2.96天。出院到住院机构的比率从44%下降到28%。30天全因再入院率从7%降至5%; 60天全因再入院率从11%降至6%; 90天全因再入院率从13%降至8%。每次发作的平均90天成本降低了20%。对初次全关节置换术实施Medicare BPCI模型2的中期结果表明，与第1年相比，第3年的LOS降低，住院设施出院率降低，再入院率降低，护理费用降低，从而增加了参与这一举措的所有利益攸关方的价值，并表明有可能在最初成果的基础上继续改进。
Background: In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation.Methods: Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons.Results: There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%.Conclusions: Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.