What’s the Best Strategy to Minimize After-care Costs for Total Joint Replacement in a Bundled Payment Environment?

Abstract Background 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. Methods We used decision analysis to examine the impact of extending the inpatient hospital stay in order to avoid discharge of patients to a post-acute rehabilitation facility. Results The results of this decision analysis shows 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. Conclusion The data demonstrates that because the cost of additional acute care hospital days are 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 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.