Predicting the Incremental Hospital Cost of Adverse Events Among Medicare Beneficiaries in the Comprehensive Joint Replacement Program During Fiscal Year 2014

Abstract Background The Medicare program’s Comprehensive Care for Joint Replacement (CJR) payment model places hospitals at financial risk for the treatment cost of Medicare beneficiaries (MB) undergoing lower extremity joint replacement (LEJR). Methods This study uses Medicare Provider Analysis and Review File and identified 674,777 MBs with LEJR procedure during fiscal year 2014. Adverse events (death, acute myocardial infarction, pneumonia, sepsis or shock, surgical site bleeding, pulmonary embolism, mechanical complications, and periprosthetic joint infection) were studied. Multi-variable regressions were modeled to estimate the incremental hospital cost of treating each adverse event. Results The risk-adjusted estimated hospital cost of treating adverse events varied from a high of $29,061 (MBs experiencing hip fracture and joint infection) to a low of $6,308 (MBs without hip fracture that experienced pulmonary embolism). Conclusion Avoidance of adverse events in the LEJR hospitalization will play an important role in managing episode hospital costs in the CJR program.