Identification of Surgeon Outliers to Improve Cost Efficiency: A Novel Use of the Centers for Medicare and Medicaid Quality Payment Program.
Centers for Medicare & Medicaid Quality Payment Program
Cost-Efficiency
Total Hip Arthroplasty
Total Knee Arthroplasty
Journal
The Journal of arthroplasty
ISSN: 1532-8406
Titre abrégé: J Arthroplasty
Pays: United States
ID NLM: 8703515
Informations de publication
Date de publication:
09 May 2024
09 May 2024
Historique:
received:
09
11
2023
revised:
30
04
2024
accepted:
01
05
2024
medline:
12
5
2024
pubmed:
12
5
2024
entrez:
11
5
2024
Statut:
aheadofprint
Résumé
Bundled payment programs for total joint arthroplasty (TJA) have become popular among both private and public payers. Because these programs provide surgeons with financial incentives to decrease costs through reconciliation payments, there is an advantage to identifying and emulating cost-efficient surgeons. The objective of this study was to utilize the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) in combination with institutional data to identify cost-efficient surgeons within our region and, subsequently, identify cost-saving practice patterns. Data was obtained from the CMS QPP for total knee (TKA) and total hip (THA) surgeons within a large metropolitan area from January 2019 to December 2021. A simple linear regression determined the relationship between surgical volume and cost-efficiency. Internal practice financial data determined whether patients of identified surgeons differed with respect to x-ray visits, physical therapy visits, out-of-pocket payments to the practice, and whether surgery was done in hospital or surgical center settings. There were four TKA and three THA surgeons who were cost-efficiency outliers within our area. Outliers and non-outlier surgeons had patients who had similar BMI, ASA, and age-adjusted CCI scores. Patients of these surgeons had fewer x-ray visits for both TKA and THA (1.06 versus 1.11, P < 0.001; 0.94 versus 1.15, P < 0.001) and lower out-of-pocket costs ($86.10 versus $135.46, P < 0.001; $116.10 versus $177.40, P < 0.001). If all surgeons performing > 30 CMS cases annually within our practice achieved similar cost-efficiency, the savings to CMS would be $17.2 million for TKA alone ($75,802,705 versus $93,028,477). The CMS QPP can be used to identify surgeons who perform cost-efficient surgeries. Practice patterns that result in cost savings can be emulated to decrease the cost curve, resulting in reconciliation payments to surgeons and institutions and cost savings to CMS.
Sections du résumé
BACKGROUND
BACKGROUND
Bundled payment programs for total joint arthroplasty (TJA) have become popular among both private and public payers. Because these programs provide surgeons with financial incentives to decrease costs through reconciliation payments, there is an advantage to identifying and emulating cost-efficient surgeons. The objective of this study was to utilize the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) in combination with institutional data to identify cost-efficient surgeons within our region and, subsequently, identify cost-saving practice patterns.
METHODS
METHODS
Data was obtained from the CMS QPP for total knee (TKA) and total hip (THA) surgeons within a large metropolitan area from January 2019 to December 2021. A simple linear regression determined the relationship between surgical volume and cost-efficiency. Internal practice financial data determined whether patients of identified surgeons differed with respect to x-ray visits, physical therapy visits, out-of-pocket payments to the practice, and whether surgery was done in hospital or surgical center settings.
RESULTS
RESULTS
There were four TKA and three THA surgeons who were cost-efficiency outliers within our area. Outliers and non-outlier surgeons had patients who had similar BMI, ASA, and age-adjusted CCI scores. Patients of these surgeons had fewer x-ray visits for both TKA and THA (1.06 versus 1.11, P < 0.001; 0.94 versus 1.15, P < 0.001) and lower out-of-pocket costs ($86.10 versus $135.46, P < 0.001; $116.10 versus $177.40, P < 0.001). If all surgeons performing > 30 CMS cases annually within our practice achieved similar cost-efficiency, the savings to CMS would be $17.2 million for TKA alone ($75,802,705 versus $93,028,477).
CONCLUSION
CONCLUSIONS
The CMS QPP can be used to identify surgeons who perform cost-efficient surgeries. Practice patterns that result in cost savings can be emulated to decrease the cost curve, resulting in reconciliation payments to surgeons and institutions and cost savings to CMS.
Identifiants
pubmed: 38734329
pii: S0883-5403(24)00434-0
doi: 10.1016/j.arth.2024.05.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Elsevier Inc. All rights reserved.