title: What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?
abstract: The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies.
  
  
  
  We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility.
  
  
  
  The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted.
  
  
  
  The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY.
authors.forename: James D
authors.initials: JD
authors.lastname: Slover
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Mullaly
authors.affiliation: University of Nevada School of Medicine, Reno, NV.
authors.forename: Ashley
authors.initials: A
authors.lastname: Payne
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bosco
mesh_terms: D019643:Arthroplasty, Replacement / Q000191:economics* / Q000534:rehabilitation; D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D003362:Cost-Benefit Analysis; D005102:Health Expenditures; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D064872:Patient Care Bundles / Q000191:economics; D010351:Patient Discharge / Q000191:economics*; D019467:Subacute Care / Q000191:economics*
keywords: bundled payment; cost-effectiveness; discharge disposition; length of stay; total joint arthroplasty