| Controlling costs without compromising quality: paying hospitals for total knee replacement. | |
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MedLine Citation:
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PMID: 20808259 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. METHODS: The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. RESULTS: Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P < 0.001; χ) and 9.9% lower risk-adjusted total costs ($12,773-$11,512; P < 0.001; t test) than all study hospitals. Inefficiency accounted for 96% of excess costs. CONCLUSIONS: A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care. |
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Authors:
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Michael Pine; Donald E Fry; Barbara L Jones; Roger J Meimban; Gregory J Pine |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Medical care Volume: 48 ISSN: 1537-1948 ISO Abbreviation: Med Care Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-22 Completed Date: 2010-10-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0230027 Medline TA: Med Care Country: United States |
Other Details:
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Languages: eng Pagination: 862-8 Citation Subset: IM |
Affiliation:
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Michael Pine and Associates, Chicago, IL 60615, USA. michaelorjoan@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Arthroplasty, Replacement, Knee / economics*, statistics & numerical data Cost Control / statistics & numerical data Cost-Benefit Analysis Efficiency, Organizational Fee-for-Service Plans / economics Female Hospital Charges / statistics & numerical data* Hospital Costs / statistics & numerical data* Humans Length of Stay / economics Male Middle Aged Osteoarthritis, Knee / economics Reimbursement Mechanisms / economics* United States Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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