ArticleThe Journal of arthroplasty2019
Changes in Discharge to Rehabilitation: Potential Unintended Consequences of Medicare Total Hip Arthroplasty/Total Knee Arthroplasty Bundled Payments, Should They Be Implemented on a Nationwide Scale?
Article in The Journal of arthroplasty, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- A Novel Failure Interface in Constrained Total Hip Arthroplasty: Dissociation at the Constrained Liner Insert-Bipolar Head Junction Following Periprosthetic Joint Infection.Journal of orthopaedic case reports · 2026Article
- Optimizing Early Recovery Quality in Same-Day Discharge Total Hip Arthroplasty: A Narrative Review.Clinical interventions in aging · 2026Review
- Early Readmission and Revision After Total Joint Arthroplasty: An Analysis of Cause and Cost.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2024Article
- Did Payment Reform Lead to Patient Selection in Hip and Knee Arthroplasties? An Observational Study Using New York State Data.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2024Article
- Assessment Tools for the Admission of Older Adults to Inpatient Rehabilitation: A Scoping Review.Journal of clinical medicine · 2023Article
- Poor Recovery of Activities-of-Daily-Living Function Is Associated With Higher Rates of Postsurgical Hospitalization After Total Joint Arthroplasty.Physical therapy · 2021Article
- CORR Insights®: Preoperative Activities of Daily Living Dependency Is Associated With Higher 30-Day Readmission Risk for Older Adults After Total Joint Arthroplasty.Clinical orthopaedics and related research · 2020Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundAs a part of the 2010 Affordable Care Act, Medicare was committed to changing 50% of its reimbursement to alternative payment models by 2018. One strategy included introduction of "bundled payments" or a fixed price for an episode of care. Early studies of the first operative bundles for elective total hip and knee arthroplasty (THA/TKA) suggest changes in discharge to rehabilitation. It remains unclear the extent to which such changes affect patient well-being. In order to address these concerns, the objective of this study is to estimate projected changes in discharge to various type of rehabilitation, 90-day outcomes, extent of therapy received, and patient health-related quality-of-life before and after introduction of bundled payments should they be implemented on a nationwide scale.
methodsA nationwide policy simulation was conducted using decision-tree methodology in order to estimate changes in overt and patient-centered outcomes. Model parameters were informed by published research on bundled payment effects and anticipated outcomes of patients discharged to various types of rehabilitation.
resultsFollowing bundled payment introduction, discharge to inpatient rehabilitation facilities decreased by 16.9 percentage-points (95% confidence interval [CI] 16.5-17.3) among primary TKA patients (THA 16.8 percentage-points), a relative decline from baseline of 58.9%. Skilled nursing facility use fell by 24.0 percentage-points (95% CI 23.6-24.4). It was accompanied by a 36.7 percentage-point (95% CI 36.3-37.2) increase in home health agency use. Although simulation models predicted minimal changes in overt outcome measures such as unplanned readmission (TKA +0.8 percentage-points), changes in discharge disposition were accompanied by significant increases in the need for further assistive care (TKA +8.0 percentage-points) and decreases in patients' functional recovery and extent of therapy received. They collectively accounted for a 30% reduction in recovered motor gains.
conclusionThe results demonstrate substantial changes in discharge to rehabilitation with accompanying declines in average functional outcomes, extent of therapy received, and health-related quality-of-life. Such findings challenge notions of reduced cost at no harm previously attributed to the bundled payment program and lend credence to concerns about reductions in access to facility-based rehabilitation.
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