Financial impact of removal of total knee arthroplasty from the inpatient-only list for a physician-owned BPCI program

James M Rizkalla; Aamir A Bhimani; Kurt J Kitziger; Paul C Peters Jr; Richard D Schubert; Brian P Gladnick

doi:10.1016/j.jor.2020.01.045

Financial impact of removal of total knee arthroplasty from the inpatient-only list for a physician-owned BPCI program

J Orthop. 2020 Jan 30:20:221-223. doi: 10.1016/j.jor.2020.01.045. eCollection 2020 Jul-Aug.

Authors

James M Rizkalla¹, Aamir A Bhimani¹, Kurt J Kitziger^{2

3}, Paul C Peters Jr^{2

3}, Richard D Schubert^{2

3}, Brian P Gladnick^{2

3}

Affiliations

¹ Baylor Univeristy Medical Center, Department of Orthopaedic Surgery, 3500 Gaston Ave, Dallas, TX, 75246, USA.
² W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA.
³ Texas Health Presbyterian Hospital Dallas, Department of Orthopaedic Surgery, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA.

Abstract

Objective: Assessing financial effects of removal of TKA from CMS inpatient-only list on physician-owned bundles.

Methods: We determined whether Medicare TKAs remained inpatient, versus changed to observational. We used CMS data to determine savings. Direct costs associated with BPCI were calculated.

Results: 7/28 TKAs (25.0%) had inpatient status changed to observational, excluding them from BPCI. Estimated savings losses were $24,332. Direct costs for administrating BPCI were $51,250. Had the rate of patients changed to observational been 50%, bundle savings from remaining patients would be less than direct costs.

Conclusion: Removing TKA from CMS inpatient-only list may have negative financial implications.

Keywords: Bundled payments; Cost; Inpatient; Total knee arthroplasty.