title: Medicare's Hospital-Acquired Conditions Policy: A Problem of Nonpayment After Total Joint Arthroplasty.
abstract: Total joint arthroplasty (TJA) utilization continues to increase, and optimizing efficiency while reducing complications is critical to provide a sustainable product. Recent policy has defined several hospital-acquired conditions (HACs) that are the target of reducing complications with significant financial implications. The present study defines the incidence of HACs after TJA as well as patient and hospital factors associated with HACs.
  
  
  
  The National Inpatient Sample (NIS) was used to identify all patients from 2009 to 2011 undergoing elective total hip or knee arthroplasty. Patient demographics, comorbidities, and hospital characteristics were obtained from the database, and HACs defined according to established International Classification of Diseases, Ninth Revision, Clinical Modification criteria. The incidence of HACs after TJA was calculated, as were demographic factors and preadmission comorbidities associated with HACs using bivariate and multivariable analysis.
  
  
  
  The overall incidence of HACs after TJA was 1.3%. Several patient and hospital factors, including increased age, female gender, black race, medium hospital bed size, year of surgery, and Charlson Comorbidity Index ≥1, independently predicted development of a HAC. When evaluating the financial impact of the development of a HAC after TJA, more than 200 million dollars in hospital costs would be lost during the inclusive years of this study, equating to nearly 70 million dollars annually.
  
  
  
  The incidence of HACs after TJA is 1.3%. Many of the patient factors associated with HACs are nonmodifiable, and risk adjustment should be considered to provide a sustainable product to a diverse patient population.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Duchman
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Bedard
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006291:Health Policy; D017721:Hospital Costs; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics* / Q000453:epidemiology*; D015994:Incidence; D007297:Inpatients; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D018570:Risk Assessment; D014481:United States
keywords: National Inpatient Sample; hospital-acquired conditions; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty