Do Higher Volume Hospitals=Better Value in Hip, Knee Revision?
Research recently presented at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that low volume hospitals had a higher mean hospital-specific charge when it comes to hip and knee revisions.
The study, “Do higher-volume hospitals provide better value in revision hip and knee arthroplasty?” appears in the December 2017 edition of The Bone & Joint Journal.
Nicholas B. Frisch, M.D., M.B.A. is a hip and knee replacement surgeon at the DeClaire LaMacchia Orthopaedic Institute in Rochester, Michigan, and was a co-author on the study. Dr. Frisch told OTW, “There have been others who have reported on concept of volume and quality. Both hospital and surgeon volume have been studied. Higher volume hospitals have been associated with lower risk of complications following TKA and THA [total hip arthroplasty]. Few studies have reported on whether higher volume also correlates with lower cost of care.”
“We used the CMS (Centers for Medicare and Medicaid Services) Hospital Compare Database which includes data on 4,788 hospitals. We also accessed the Medicare Provider Utilization and Payment Data Inpatient Charge Data for 2014. We excluded hospitals with <11 DRG [Diagnosis-Related Group] episodes during the year studied. We identified all hospitals with data from patients in DRG 470. Ultimately, we identified 2,702 hospitals, [that] performed a total of 458,259 primary arthroplasty procedures in 2014. Low performing defined as <100 procedures per year. We collected patient satisfaction scores and 30-day readmission and risk-adjusted complications.”
Craig Della Valle, M.D. is chief of Adult Reconstructive Surgery and Professor of Orthopaedic Surgery at Rush University Medical Center. Dr. Della Valle, also a co-author on the study, told OTW, “In our study, 47% of hospitals were classified as low volume; low volume hospitals performed only 12% of primary joint arthroplasty cases. We also found that low volume hospitals had a higher mean hospital-specific charge and were more likely to be in a non-urban area. High volume hospitals had a higher star rating and performed better on every HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] metric.”
Dr. Frisch added, “Low volume facilities could potentially benefit from adopting some of the practices in place from high volume centers.”
