期刊
JOURNAL OF ARTHROPLASTY
卷 37, 期 7, 页码 S408-S412出版社
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.arth.2022.02.101
关键词
COVID-19 pandemic; total hip arthroplasty; inpatient-only rule; outpatient arthroplasty; surgical volume
类别
Changes in demand, capacity, and site of service have affected the volume and revenues of total hip arthroplasty (THA) over the 2019-2021 period. The removal of THA from the inpatient-only (IPO) list and the COVID-19 pandemic have led to a decrease in demand and a shift in delivery away from inpatient services. Medicare claims data were analyzed to compare the metrics of THA before and after these changes. The results showed a decrease in THA volume, length of stay, and Medicare spending, as well as an increase in outpatient and same-day discharge cases.
Background: Shifts in demand, capacity, and site of service have impacted total hip arthroplasty (THA) volumes and revenues over the 2019-2021 time period. Moving THA off the inpatient-only (IPO) list and the COVID-19 pandemic has caused a shift in delivery away from inpatient services and a decrease in demand. Methods: Medicare claims data were surveyed for the latest period available (April 1, 2020 to September 2020) and compared with a similar period in 2019 prior to THA removal from the IPO list and before the COVID-19 pandemic. Length of stay (LOS), admission status, site of service, discharge status, cost to CMS (Centers of Medicaid and Medicare Services), and racial disparities were analyzed. Results: From 2019 to 2020, changes in primary THA metrics occurred (overall change in total joint arthroplasty [THA plus total knee arthroplasty metrics]): CMS THA volume decreased from 78,691 to 65,360, -16% (-22%); THA performed as an outpatient increased from 0% to 51% (141%); THA performed as same-day discharge increased from 3% to 12%, 325% (221%); overall LOS decreased from 1.91 to 1.46, -23% (-11%); inpatient LOS increased from 1.92 to 2.05, 7% (16%); outpatient LOS increased from 0.92 to 0.93, 1% (-12%); discharge home increased from 82% to 91%, 12.8% (11%); and CMS spending decreased from $1,033 million to $751 million, -27% (-27%). Conclusion: Medicare payments, LOS, discharge to facilities, and volume declined from 2019 to 2020 and were accelerated by IPO list changes and COVID-19 issues. Same-day discharge and hospital outpatient department cases also increased. THA metrics were not affected by race. (C) 2022 Elsevier Inc. All rights reserved.
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