ED visits 'frequent' following TJR, significant for CJR implementation: 5 study insights


Healthcare facilities that offer joint replacement should consider the frequency of emergency department visits when implementing bundled payments, according to a study published in Academic Emergency Medicine.

The researchers identified 50,838 total joint replacement surgeries that were performed in Texas in 2011 and 2012, which would have been eligible for inclusion in CMS' new Comprehensive Care for Joint Replacement program. They analyzed 90-day post-discharge emergency department visits for those who underwent elective total hip replacement, emergent total hip replacement and total knee replacement.


Here's what you need to know:


1. Of the 50,838 total joint replacement cases, there were 12,747 emergency department visits by 9,299 patients.


2. Of the 10,786 elective total hip replacement cases, there were 2,370 emergency department visits; 55.5 percent were discharged home, 34.6 percent were hospitalized or transferred and 6.9 percent were admitted to observation.


3. Of the 8,475 emergent hip replacement cases, there were 3,438 emergency department visits; 22.4 percent were discharged home, 50.2 percent were hospitalized or transferred and 5.3 percent were admitted to observation.


4. Of the 31,387 total knee replacement cases, there were 6,939 emergency department visits; 61.9 percent were discharged home, 30.6 percent were readmitted or transferred and 7.1 percent were admitted to observation.


5. The most prevalent diagnoses, across the groups, included injury/trauma, physiologic decompensation, cardiopulmonary events and infection.


The researchers concluded that "ED services are frequent for Medicare total joint replacement bundle-eligible patients within the post-discharge period." They suggest healthcare facilities consider the importance of emergency department services when identifying and managing postoperative outcomes in bundled payment plans.


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