Global Budget Revenue on a Single Institution's Costs, Outcomes, and Patient Quality Metrics in Patients Undergoing Total Knee Arthroplasty.

BACKGROUND: Maryland was granted a waiver to implement a Global Budget Revenue (GBR) reimbursement model. Statewide results for combined medical and surgical services have been reported for fiscal years 2015 and 2016. A paucity of studies exists exploring the change in care costs and outcomes for total knee arthroplasty (TKA) recipients under GBR. This study aims to assess the effects of GBR on cost of care and resource utilization related to TKA at a single institution before and after GBR. METHODS: The Maryland Center for Medicare and Medicaid Services database was used to find Medicare patients who underwent TKA at a single institution before (2012-2013) and after (2014-2015) GBR. A total of 150 and 161 TKAs were performed in 2012 and 2015. Cost differences were compared for each inpatient care episode, postacute care period, and readmissions. We also evaluated differences in length of stay, discharge disposition, and complication rates. RESULTS: Mean inpatient cost was significantly lower in 2015 vs 2012 (P = .0014); however, analysis of postacute costs showed a nonsignificant increase in price between years (P = .1008). We demonstrated significant increase in home health (P < .0001) and significant decrease in acute rehabilitation (P = .0481). Durable medical equipment costs significantly decreased (P = .0087). CONCLUSION: We demonstrate lower mean inpatient costs since GBR initiation. We reveal increased mean postacute care costs, which may be due to increased acuity for patients needing postacute care. Our results show nonsignificant reductions in length of stay, complications, and increased rate of home discharge, suggesting GBR may be effective in orchestrating reduced costs for TKA at high-volume institutions.

Global Budget Revenue on a Single Institution's Costs and Outcomes in Patients Undergoing Total Hip Arthroplasty.

BACKGROUND: The state of Maryland was granted a waiver by the Center for Medicare and Medicaid Services to implement a Global Budget Revenue (GBR) reimbursement model. This study aims to compare (1) costs of inpatient hospital stays; (2) postacute care costs; (3) lengths of stay (LOS); and (4) discharge disposition who underwent primary total hip arthroplasty at a single Maryland-based orthopedic institution before and after the implementation of GBR. METHODS: The Maryland Center for Medicare and Medicaid Services database was queried to obtain all Medicare patients who underwent total hip arthroplasty at a single institution before and after the implementation of GBR. We compared the differences in costs for the following: inpatient care, the postacute care period, and readmissions. In addition, we evaluated differences in LOS, discharge disposition, and complication rates. RESULTS: There was a significant decrease in inpatient costs ($26,575 vs $23,712), an increase in mean home health costs ($627 vs 1608), and a decrease in mean durable medical equipment costs ($604 vs $82) and LOS (2.92 days vs 2.33 days). There was an increase in discharge to home rates (72.3% vs 78.9%) and a decrease in discharge to acute rehabilitation (4.3% vs 1.8%) CONCLUSION: Under the GBR model, our institution experienced significant cost savings during the inpatient and postacute care episodes. Thus, GBR may serve as a viable solution to reducing costs to Medicare for high-volume arthroplasty institutions with a large Medicare population. Multicentered studies are needed to verify our results.