Title of Presentation

Oncology patients incur significantly higher costs under the current bundled payment model for total joint replacement

Presenter Biography

Lauren Raymond is a second year medical student at Oregon Health & Science University. Prior to medical school, Lauren worked in orthopaedics for several years and currently has an interest in cost effectiveness research.

Institution

OHSU

Degree

MD

Presentation Type

Poster

Room Location

Smith Memorial Student Union, Room 296/8

Start Date

April 2019

End Date

April 2019

Abstract

Introduction: In 2016, the Centers for Medicare and Medicaid Services (CMS) implemented the Comprehensive Care for Joint Replacement (CJR) model, a bundled payment system which requires hospitals to account for the cost and quality of a 90-day episode of care.

The objective of this study was to compare costs in patients enrolled in the CJR model undergoing joint replacement for local hip or knee tumors versus primary osteoarthritis.

Methods: We performed a retrospective review of bundle-eligible patients undergoing joint replacement for local tumor or osteoarthritis at OHSU from 2016-2018. Abstracted chart data included age, BMI, smoking status, and medical comorbidities. Hospital cost data was provided by OHSU financial services. Rates of reimbursement were provided by CMS. We compared costs between groups using two-tailed t-tests. We created a linear regression model with a log-link to adjust for covariates.

Results: 370 patients met inclusion criteria; 15 had a joint replacement for primary or metastatic tumor, and 355 for osteoarthritis. Mean hospital costs were significantly higher in tumor patients ($37,152 vs $16,824, p<0.001). The inclusion of other covariates including gender, age, obesity, diabetes, smoking, and bleeding disorders did not alter the statistical significance of the association between oncologic diagnosis and higher costs.

Conclusion: Oncology patients enrolled in the CJR bundle incur significantly higher costs than patients with primary osteoarthritis. As costs associated with these patients exceed the CJR reimbursement, we recommend that oncology patients be excluded from the CJR bundle.

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Apr 3rd, 5:00 PM Apr 3rd, 6:00 PM

Oncology patients incur significantly higher costs under the current bundled payment model for total joint replacement

Smith Memorial Student Union, Room 296/8

Introduction: In 2016, the Centers for Medicare and Medicaid Services (CMS) implemented the Comprehensive Care for Joint Replacement (CJR) model, a bundled payment system which requires hospitals to account for the cost and quality of a 90-day episode of care.

The objective of this study was to compare costs in patients enrolled in the CJR model undergoing joint replacement for local hip or knee tumors versus primary osteoarthritis.

Methods: We performed a retrospective review of bundle-eligible patients undergoing joint replacement for local tumor or osteoarthritis at OHSU from 2016-2018. Abstracted chart data included age, BMI, smoking status, and medical comorbidities. Hospital cost data was provided by OHSU financial services. Rates of reimbursement were provided by CMS. We compared costs between groups using two-tailed t-tests. We created a linear regression model with a log-link to adjust for covariates.

Results: 370 patients met inclusion criteria; 15 had a joint replacement for primary or metastatic tumor, and 355 for osteoarthritis. Mean hospital costs were significantly higher in tumor patients ($37,152 vs $16,824, p<0.001). The inclusion of other covariates including gender, age, obesity, diabetes, smoking, and bleeding disorders did not alter the statistical significance of the association between oncologic diagnosis and higher costs.

Conclusion: Oncology patients enrolled in the CJR bundle incur significantly higher costs than patients with primary osteoarthritis. As costs associated with these patients exceed the CJR reimbursement, we recommend that oncology patients be excluded from the CJR bundle.