PMID- 35314286
OWN - NLM
STAT- MEDLINE
DCOM- 20220706
LR  - 20220804
IS  - 1532-8406 (Electronic)
IS  - 0883-5403 (Linking)
VI  - 37
IP  - 8S
DP  - 2022 Aug
TI  - The Hip and Femur Fracture Bundle: Preliminary Findings From a Tertiary Hospital.
PG  - S761-S765
LID - S0883-5403(22)00344-8 [pii]
LID - 10.1016/j.arth.2022.03.059 [doi]
AB  - BACKGROUND: The voluntary hip and femur fracture Bundled Payments for Care 
      Improvement Advanced (BCPI-A) includes Diagnosis Related Groups (DRG) 480, 481, 
      and 482, which include diverse and medically complex patients undergoing urgent 
      inpatient surgery without optimization. Concern exists that this bundle is 
      financially unfavorable for hospitals, and this study aimed to identify the 
      costliest services. METHODS: We retrospectively reviewed a 12-month cohort of 32 
      consecutive patients in the DRG 480-482 bundle at our academic tertiary referral 
      center. Cost of discharge disposition, readmission, and other variables were 
      analyzed for all patients in the 90-day bundle. RESULTS: Overall, a net financial 
      gain averaging $2,028 per patient (range -$52,128 to +$30,199) was seen. 
      Discharge to facilities (n = 19) resulted in higher costs than discharge to home 
      (n = 11, P < .0001). Use of inpatient rehabilitation (n = 6) averaged a loss of 
      $11,028 per patient and use of skilled nursing facilities (n = 15) averaged a 
      loss of $7,250 per patient, compared to a gain of $15,011 for patients discharged 
      home (n = 11). Episodes with readmission (n = 6) averaged a loss of only $1,390. 
      Total index admission costs averaged $12,489 +/- $2,235 per patient (range 
      $9,329-$18,884) while post-inpatient cost averaged $30,150 per patient (range 
      $4,803 - $77,768). CONCLUSION: The BPCI-A hip and femur fracture bundle has a 
      wide variability in costs, with the largest component in the post-acute care 
      phase. Discharge home is favorable in the bundle while discharge to post-acute 
      facilities leads to net losses. Institutions in this bundle need to develop 
      multi-disciplinary teams to promote safe discharge home.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Cooper, Kasa B
AU  - Cooper KB
AD  - Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 
      Little Rock, Arkansas.
FAU - Mears, Simon C
AU  - Mears SC
AD  - Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 
      Little Rock, Arkansas.
FAU - Siegel, Eric R
AU  - Siegel ER
AD  - Department of Biostatistics, University of Arkansas for Medical Sciences, Little 
      Rock, Arkansas.
FAU - Stambough, Jeffrey B
AU  - Stambough JB
AD  - Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 
      Little Rock, Arkansas.
FAU - Bumpass, David B
AU  - Bumpass DB
AD  - Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 
      Little Rock, Arkansas.
FAU - Cherney, Steven M
AU  - Cherney SM
AD  - Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 
      Little Rock, Arkansas.
LA  - eng
PT  - Journal Article
DEP - 20220318
PL  - United States
TA  - J Arthroplasty
JT  - The Journal of arthroplasty
JID - 8703515
SB  - IM
MH  - *Arthroplasty, Replacement, Hip
MH  - *Femoral Fractures/surgery
MH  - Femur
MH  - Humans
MH  - Medicare
MH  - *Patient Care Bundles
MH  - Patient Discharge
MH  - Patient Readmission
MH  - Retrospective Studies
MH  - Skilled Nursing Facilities
MH  - Tertiary Care Centers
MH  - United States
OTO - NOTNLM
OT  - bundle
OT  - bundle buster
OT  - fracture cost
OT  - hip and femur fracture
OT  - post-acute care cost
EDAT- 2022/03/23 06:00
MHDA- 2022/07/07 06:00
CRDT- 2022/03/22 05:34
PHST- 2021/12/06 00:00 [received]
PHST- 2022/03/14 00:00 [revised]
PHST- 2022/03/15 00:00 [accepted]
PHST- 2022/03/23 06:00 [pubmed]
PHST- 2022/07/07 06:00 [medline]
PHST- 2022/03/22 05:34 [entrez]
AID - S0883-5403(22)00344-8 [pii]
AID - 10.1016/j.arth.2022.03.059 [doi]
PST - ppublish
SO  - J Arthroplasty. 2022 Aug;37(8S):S761-S765. doi: 10.1016/j.arth.2022.03.059. Epub 
      2022 Mar 18.