Abstract
As we shift from a fee-for-service to value-based reimbursement system, it is critical
that orthopaedic surgeons assess all characteristics of the patient prior to surgical
intervention. The purpose of this study was to evaluate the relationship of payer
type and disposition on direct and indirect measures of resource consumption (length-of-stay
[LOS], hospital cost, and 30-day readmission). Patients equal to or more than 55 years
of age with radiographic evidence of hip fracture necessitating surgical intervention
were included. Initially, baseline characteristics, including age, body mass index
(BMI), American Society of Anesthesiologist (ASA) score, fracture type, and instrumentation,
were reported by payer type (private versus Medicare) and disposition (skilled nursing
facility [SNF], home, and home health). In the second phase, the independent effects
of payer type and disposition on resource consumption were evaluated. Lastly, the
impact of payer type and day of admission on disposition were assessed. A total of
478 patients met the inclusion criteria. Evaluation of baseline characteristics demonstrated
that age and ASA scores were significantly higher within the Medicare and SNF cohorts,
when compared with private payers and home/home health, respectively. Medicare as
a payer type resulted in an increased LOS (5.6 versus 4.5 days) and greater hospital
cost (12.1%) than private payers. Moreover, payer type was not predictive of 30-day
readmission. Disposition following operative fixation resulted in an average LOS of
5.8, 4.4, and 4 days for patients discharged to SNF, home, and home health, respectively.
No significant difference in hospital stay was noted between home and home health
patients. Compared with patients discharged home, in-hospital cost was 33.9 and 12.3%
greater for the SNF and home heath cohorts, respectively. Finally, 21.6% of patients
discharged to a SNF were readmitted within 30 days. Our results indicate Medicare
patients and those discharged to a SNF are more likely to have longer LOS and incur
greater costs. Additionally, 30-day readmission is significantly higher in patients
discharged to SNF. Thus, patients with hip fracture should be rigorously optimized
within the preoperative setting to enhance clinical outcomes. Moreover, additional
resources should be allocated to the higher risk patients.
Keywords
hip fracture - resource utilization - discharge disposition - day of admission - payer
type
