The Experts below are selected from a list of 252 Experts worldwide ranked by ideXlab platform
Safdar N. Khan - One of the best experts on this subject based on the ideXlab platform.
-
Shoulder Arthroplasty for a Fracture Is Not the Same as Shoulder Arthroplasty for Osteoarthritis: Implications for a Bundled Payment Model.
The Journal of the American Academy of Orthopaedic Surgeons, 2019Co-Authors: Azeem Tariq Malik, Julie Y. Bishop, Andrew S. Neviaser, Corey T Beals, Nikhil Jain, Safdar N. KhanAbstract:INTRODUCTION The Center for Medicare Services currently bundles all shoulder arthroplasties, total shoulder arthroplasty and reverse total shoulder arthroplasty, into one Diagnosis-Related Group on which bundled reimbursements are then further characterized. An arthroplasty performed for traumatic indications, such as fractures, may have a different postoperative course of care compared with the one being done for degenerative arthritis/osteoarthritis (OA), despite having the same Current Procedural Terminology (CPT) and Diagnosis-Related Group code. METHODS The 2012 to 2016 American College of Surgeons-National Surgical Quality Improvement Program databases were queried using CPT-23472 to retrieve records of patients undergoing total shoulder arthroplasty/reverse total shoulder arthroplasty for degenerative arthritis/OA or proximal humerus fracture. RESULTS A total of 8,283 (92.5%) and 667 (7.5%) patients underwent a shoulder arthroplasty for OA and proximal humeral fracture, respectively. After adjustment, the fracture Group was associated with a higher risk for a longer length of stay of >2 days (P < 0.001), 30-day surgical complications (P = 0.005), revision surgeries within 30 days (P = 0.008), 30-day medical complications (P < 0.001), pulmonary embolism (P = 0.013), postoperative transfusions (P < 0.001), non-home discharge (P < 0.001), and 30-day readmissions (P < 0.001). DISCUSSION Shoulder arthroplasty is associated with higher resource utilization when this procedure is performed for a fracture. As we move toward the era of bundled payment models, an appropriate risk adjustment based on the indication of surgery should be promoted to maintain the quality of care for all patients.
Richard Iorio - One of the best experts on this subject based on the ideXlab platform.
-
hospital economics of primary total knee arthroplasty at a teaching hospital
Clinical Orthopaedics and Related Research, 2011Co-Authors: William L Healy, Adam J Rana, Richard IorioAbstract:Background The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system.
Azeem Tariq Malik - One of the best experts on this subject based on the ideXlab platform.
-
Shoulder Arthroplasty for a Fracture Is Not the Same as Shoulder Arthroplasty for Osteoarthritis: Implications for a Bundled Payment Model.
The Journal of the American Academy of Orthopaedic Surgeons, 2019Co-Authors: Azeem Tariq Malik, Julie Y. Bishop, Andrew S. Neviaser, Corey T Beals, Nikhil Jain, Safdar N. KhanAbstract:INTRODUCTION The Center for Medicare Services currently bundles all shoulder arthroplasties, total shoulder arthroplasty and reverse total shoulder arthroplasty, into one Diagnosis-Related Group on which bundled reimbursements are then further characterized. An arthroplasty performed for traumatic indications, such as fractures, may have a different postoperative course of care compared with the one being done for degenerative arthritis/osteoarthritis (OA), despite having the same Current Procedural Terminology (CPT) and Diagnosis-Related Group code. METHODS The 2012 to 2016 American College of Surgeons-National Surgical Quality Improvement Program databases were queried using CPT-23472 to retrieve records of patients undergoing total shoulder arthroplasty/reverse total shoulder arthroplasty for degenerative arthritis/OA or proximal humerus fracture. RESULTS A total of 8,283 (92.5%) and 667 (7.5%) patients underwent a shoulder arthroplasty for OA and proximal humeral fracture, respectively. After adjustment, the fracture Group was associated with a higher risk for a longer length of stay of >2 days (P < 0.001), 30-day surgical complications (P = 0.005), revision surgeries within 30 days (P = 0.008), 30-day medical complications (P < 0.001), pulmonary embolism (P = 0.013), postoperative transfusions (P < 0.001), non-home discharge (P < 0.001), and 30-day readmissions (P < 0.001). DISCUSSION Shoulder arthroplasty is associated with higher resource utilization when this procedure is performed for a fracture. As we move toward the era of bundled payment models, an appropriate risk adjustment based on the indication of surgery should be promoted to maintain the quality of care for all patients.
William L Healy - One of the best experts on this subject based on the ideXlab platform.
-
hospital economics of primary total knee arthroplasty at a teaching hospital
Clinical Orthopaedics and Related Research, 2011Co-Authors: William L Healy, Adam J Rana, Richard IorioAbstract:Background The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system.
Maxwell P Courtney - One of the best experts on this subject based on the ideXlab platform.
-
conversion total knee arthroplasty needs its own diagnosis related Group code
Journal of Arthroplasty, 2019Co-Authors: Michael Yayac, Jonah Stein, Gregory K Deirmengian, Javad Parvizi, Maxwell P CourtneyAbstract:BACKGROUND Conversion from a prior knee procedure has been demonstrated to require greater operative times and resources, but still lacks a separate procedural or facility code from primary total knee arthroplasty (TKA). The purpose of this study is to determine differences in facility costs between patients who underwent primary TKA and those who underwent conversion TKA. METHODS We retrospectively reviewed a consecutive series of patients undergoing primary TKA at 2 hospitals from 2015 to 2017, comparing itemized facility costs between primary and conversion TKA patients. A multivariate regression analysis was performed to identify independent risk factors for increased facility costs, the need for additional implants, length of stay, and discharge disposition. RESULTS Of 2447 TKA procedures, 678 (27.7%) underwent conversion TKA, which was associated with greater implant costs ($3931.47 vs $2864.67, P = .0120) and total facility costs in a multivariate regression ($94.30 increase, P = .0316). When controlling for confounding variables, patients with a prior ligament reconstruction ($402 increase, P = .0002) and prior open reduction and internal fixation ($847 increase, P = .0020) had higher costs and were more likely to require stemmed implants (P < .05). There was an increase in TKA implant cost by $538 in patients with implants from a prior procedure (P < .0001). CONCLUSION Conversion TKA is associated with greater implant and inpatient facility costs than primary TKA, particularly those who had a history of an open knee procedure. A separate Diagnosis-Related Group should be created for conversion TKA given the increased cost and complexity of these procedures compared to primary TKA.