title: Joint Replacement Volume Positively Correlates With Improved Hospital Performance on Centers for Medicare and Medicaid Services Quality Metrics.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Sibley
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Charubhumi
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Lorraine H
authors.initials: LH
authors.lastname: Hutzler
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Albit R
authors.initials: AR
authors.lastname: Paoli
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Bosco
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D014487:Centers for Medicare and Medicaid Services, U.S.; D003428:Cross Infection / Q000191:economics; D016208:Databases, Factual; D018588:Fee-for-Service Plans; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008484:Medicaid; D006278:Medicare; D009518:New York; D010351:Patient Discharge; D010359:Patient Readmission; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D014481:United States
keywords: CMS; joint replacement; pay for performance; penalties; quality metrics; value-based purchasing