ABSTRACT
BACKGROUND: Shifts in demand, capacity, and site of service have impacted total hip arthroplasty (THA) volumes and revenues over the 2019-2021 time period. Moving THA off the inpatient-only (IPO) list and the COVID-19 pandemic has caused a shift in delivery away from inpatient services and a decrease in demand. METHODS: Medicare claims data were surveyed for the latest period available (April 1, 2020 to September 2020) and compared with a similar period in 2019 prior to THA removal from the IPO list and before the COVID-19 pandemic. Length of stay (LOS), admission status, site of service, discharge status, cost to CMS (Centers of Medicaid and Medicare Services), and racial disparities were analyzed. RESULTS: From 2019 to 2020, changes in primary THA metrics occurred (overall change in total joint arthroplasty [THA plus total knee arthroplasty metrics]): CMS THA volume decreased from 78,691 to 65,360, -16% (-22%); THA performed as an outpatient increased from 0% to 51% (141%); THA performed as same-day discharge increased from 3% to 12%, 325% (221%); overall LOS decreased from 1.91 to 1.46, -23% (-11%); inpatient LOS increased from 1.92 to 2.05, 7% (16%); outpatient LOS increased from 0.92 to 0.93, 1% (-12%); discharge home increased from 82% to 91%, 12.8% (11%); and CMS spending decreased from $1,033 million to $751 million, -27% (-27%). CONCLUSION: Medicare payments, LOS, discharge to facilities, and volume declined from 2019 to 2020 and were accelerated by IPO list changes and COVID-19 issues. Same-day discharge and hospital outpatient department cases also increased. THA metrics were not affected by race.
Subject(s)
Arthroplasty, Replacement, Hip , COVID-19 , Aged , Benchmarking , COVID-19/epidemiology , Humans , Length of Stay , Medicaid , Medicare , Pandemics , Patient Discharge , Patient Readmission , Retrospective Studies , United States/epidemiologySubject(s)
Coronavirus Infections/epidemiology , Elective Surgical Procedures/standards , Orthopedic Procedures/standards , Orthopedics/organization & administration , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Humans , Inpatients , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , SARS-CoV-2Subject(s)
Coronavirus Infections/economics , Health Care Costs , Orthopedic Procedures/economics , Pandemics/economics , Pneumonia, Viral/economics , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Hospital Costs/statistics & numerical data , Humans , Male , Orthopedic Procedures/methods , Orthopedic Procedures/statistics & numerical data , Orthopedics/economics , Pandemics/prevention & control , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , United StatesABSTRACT
BACKGROUND: The economic effects of the COVID-19 crisis are not like anything the U.S. health care system has ever experienced. METHODS: As we begin to emerge from the peak of the COVID-19 pandemic, we need to plan the sustainable resumption of elective procedures. We must first ensure the safety of our patients and surgical staff. It must be a priority to monitor the availability of supplies for the continued care of patients suffering from COVID-19. As we resume elective orthopedic surgery and total joint arthroplasty, we must begin to reduce expenses by renegotiating vendor contracts, use ambulatory surgery centers and hospital outpatient departments in a safe and effective manner, adhere to strict evidence-based and COVID-19-adjusted practices, and incorporate telemedicine and other technology platforms when feasible for health care systems and orthopedic groups to survive economically. RESULTS: The return to normalcy will be slow and may be different than what we are accustomed to, but we must work together to plan a transition to a more sustainable health care reality which accommodates a COVID-19 world. CONCLUSION: Our goal should be using these lessons to achieve a healthy and successful 2021 fiscal year.