A new retrospective study from Columbia University Medical Center has found that when doctors and skilled nursing facilities team up, total joint arthroplasty (TJA) costs go down and outcomes go up.
The research, “Effects of Skilled Nursing Facility Partnerships on Outcomes Following Total Joint Arthroplasty,” appears in the December 15, 2021, edition of the Journal of the American Academy of Orthopaedic Surgeons.
Co-author H. John Cooper, M.D., an adult reconstruction specialist at Columbia, told OTW, “Although the majority of patients undergoing total joint arthroplasty are discharged home, some still require post-acute care in skilled nursing facilities. With the increased focus on quality and value in patients undergoing total joint replacement, we wanted to investigate ways to improve outcomes for the minority of patients who still require a skilled nursing facility.”
The researchers set the stage, differentiating between facilities that were “preferred” (an informal term meaning those willing to meet certain standards expected of the partnership) and “nonpreferred.” All patients were given facilities list, with several options designated as “preferred.” The authors explained to OTW that the most substantial difference between “preferred” and “nonpreferred” skilled nursing facilities was the level of collaboration between post-acute care providers and the orthopedic staff.
Taking individuals who were part of the four-year Medicare Comprehensive Care for Joint Replacement pilot program, the researchers compared data for 189 patients (22.9%) who were discharged to skilled nursing facilities, with 128 patients (67.8%) who’d been discharged to “preferred” and 61 patients (32.2%) who’d been discharged to “nonpreferred” facilities.
Skilled nursing facilities costs and overall post-discharge costs were lower for patients who went to “preferred” skilled nursing facilities than those who were sent to “nonpreferred” skilled nursing facilities. “Preferred” facility costs were, on average, $7,343 vs $10,981 for “nonpreferred” facilities. Post-discharge costs for “preferred” facilities were on average $18,339 vs $23,952 for “nonpreferred” facilities.
Those sent to “nonpreferred” skilled nursing facilities also had an increased length of stay (14.8 days) as compared to “preferred” facilities (10.1 days). “Nonpreferred” facilities also recorded higher rates of readmission (19.7%) versus “preferred” facilities (3.9%). The authors noted that these differences became more pronounced as the study progressed.
“Multidisciplinary teams that care for total joint patients may use these data to alter practice in several ways,” said Dr. Cooper to OTW. “Most importantly, establishing a relationship and an open line of communication between your orthopedic group or hospital and a skilled nursing facility will likely improve post-acute care, reduce readmissions, and reduce costs. Additionally, ‘partnering’ with a small number of skilled nursing facilities who can provide post-acute care for patients who need it can help to strengthen and streamline post-discharge pathways and improve patient care.”
