Total joint replacements in physician-owned hospitals vs. non-POHs: 5 key notes on cost, quality

A new study published in the Journal of Bone and Joint Surgery examines the outcomes and costs associated with total joint replacements at physician-owned hospitals.

The study authors examined CMS inpatient charge data from 45 physician-owned hospitals and 2,657 non-physician-owned hospitals that performed 11 or more primary total knee and total hip replacements in 2014. Here are the key findings:

1. Medicare paid POHs $11,106 on average for total joint replacements, less than the $12,699 paid to non-physician-owned hospitals for the same procedures.

2. The 30-day readmission score was similar between physician-owned hospitals and non-physician-owned hospitals; POHs reported a 4.48 readmission rate compared to 4.62 for non-POHs.

3. POHs reported a lower risk-adjusted complication score — 2.83 — compared to non-POHs' score — 3.04.

4. Patients were more satisfied at POHs than non-POHs, which achieved better mean linear scores for the likelihood patients would recommend the hospital and overall ratings. The overall rating for the POHs was 93.4, compared with 88.4 out of 100 for the non-POHs.

5. Total joint replacements performed at the non-POHs were an independent risk factor for appearing in the upper quartile of all inpatient payments in the Medicare Severity-Diagnosis Related Group, potentially due to the difference in CMS payment methodology.

"Our findings suggest that physician-owned hospitals are associated with lower mean Medicare costs, fewer complications and higher patient satisfaction following THA and TKA than non-physician-owned hospitals," concluded the study authors. "Policymakers should consider these data when debating the current moratorium on physician-owned hospital expansion."

More articles on surgery centers:
Dr. Matthew Wallace performs The Orthopaedic Surgery Center's 100th outpatient joint replacement—4 insights
Total joints in ASCs are a win-win-win—Dr. Michael Cmell outlines key trends for the future
Outlook for total joint replacements in the ASC: Key concepts from Dr. Thomas K. Miller

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