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Joint Replacement Volume Positively Correlates With Improved Hospital Performance on Centers for Medicare and Medicaid Services Quality Metrics.
J Arthroplasty. 2017 05; 32(5):1409-1413.JA

Abstract

BACKGROUND

The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP). The objective of this study was to determine whether high-volume total joint hospitals perform better in these programs than their lower-volume counterparts.

METHODS

We analyzed data from the New York Statewide Planning and Research Cooperative System database on total New York State hospital discharges from 2013 to 2015 for total knee and total hip arthroplasty. This was compared to data from Hospital Compare on HAC's, excess readmissions, and VBP. From these databases, we identified 123 hospitals in New York, which participated in all 3 Medicare pay-for-performance programs and performed total joint replacements.

RESULTS

Over the 3-year period spanning 2013-2015, hospitals in New York State performed an average of 1136.59 total joint replacement surgeries and achieved a mean readmission penalty of 0.005909. The correlation coefficient between surgery volume and combined performance score was 0.277. Of these correlations, surgery volume and VBP performance, and surgery volume and combined performance showed statistical significance (P < .01).

CONCLUSION

Our study demonstrates that there is a positive association between joint replacement volumes and overall hospital quality, as well as joint replacement volumes and VBP performance, specifically. These findings are consistent with previously reported associations between patient outcomes and procedure volumes. However, a relationship between joint replacement volume and HAC scores or readmission penalties could not be demonstrated.

Authors+Show Affiliations

Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28089185

Citation

Sibley, Rachel A., et al. "Joint Replacement Volume Positively Correlates With Improved Hospital Performance On Centers for Medicare and Medicaid Services Quality Metrics." The Journal of Arthroplasty, vol. 32, no. 5, 2017, pp. 1409-1413.
Sibley RA, Charubhumi V, Hutzler LH, et al. Joint Replacement Volume Positively Correlates With Improved Hospital Performance on Centers for Medicare and Medicaid Services Quality Metrics. J Arthroplasty. 2017;32(5):1409-1413.
Sibley, R. A., Charubhumi, V., Hutzler, L. H., Paoli, A. R., & Bosco, J. A. (2017). Joint Replacement Volume Positively Correlates With Improved Hospital Performance on Centers for Medicare and Medicaid Services Quality Metrics. The Journal of Arthroplasty, 32(5), 1409-1413. https://doi.org/10.1016/j.arth.2016.12.010
Sibley RA, et al. Joint Replacement Volume Positively Correlates With Improved Hospital Performance On Centers for Medicare and Medicaid Services Quality Metrics. J Arthroplasty. 2017;32(5):1409-1413. PubMed PMID: 28089185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Joint Replacement Volume Positively Correlates With Improved Hospital Performance on Centers for Medicare and Medicaid Services Quality Metrics. AU - Sibley,Rachel A, AU - Charubhumi,Vanessa, AU - Hutzler,Lorraine H, AU - Paoli,Albit R, AU - Bosco,Joseph A, Y1 - 2016/12/21/ PY - 2016/06/24/received PY - 2016/12/01/revised PY - 2016/12/10/accepted PY - 2017/1/17/pubmed PY - 2017/6/16/medline PY - 2017/1/17/entrez KW - CMS KW - joint replacement KW - pay for performance KW - penalties KW - quality metrics KW - value-based purchasing SP - 1409 EP - 1413 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 5 N2 - BACKGROUND: The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP). The objective of this study was to determine whether high-volume total joint hospitals perform better in these programs than their lower-volume counterparts. METHODS: We analyzed data from the New York Statewide Planning and Research Cooperative System database on total New York State hospital discharges from 2013 to 2015 for total knee and total hip arthroplasty. This was compared to data from Hospital Compare on HAC's, excess readmissions, and VBP. From these databases, we identified 123 hospitals in New York, which participated in all 3 Medicare pay-for-performance programs and performed total joint replacements. RESULTS: Over the 3-year period spanning 2013-2015, hospitals in New York State performed an average of 1136.59 total joint replacement surgeries and achieved a mean readmission penalty of 0.005909. The correlation coefficient between surgery volume and combined performance score was 0.277. Of these correlations, surgery volume and VBP performance, and surgery volume and combined performance showed statistical significance (P < .01). CONCLUSION: Our study demonstrates that there is a positive association between joint replacement volumes and overall hospital quality, as well as joint replacement volumes and VBP performance, specifically. These findings are consistent with previously reported associations between patient outcomes and procedure volumes. However, a relationship between joint replacement volume and HAC scores or readmission penalties could not be demonstrated. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28089185/Joint_Replacement_Volume_Positively_Correlates_With_Improved_Hospital_Performance_on_Centers_for_Medicare_and_Medicaid_Services_Quality_Metrics_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(16)30895-6 DB - PRIME DP - Unbound Medicine ER -