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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 5 of 5 Research Studies DisplayedKo H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE .
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
DeKeyser GJ, Martin BI, Ko H
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
The authors compared perioperative complications and costs of total hip arthroplasty (THA) for treatment of osteoarthritis (OA) to hemiarthroplasty (HA) and THA for treatment of femoral neck fractures (FNFs). Data from CMS were used to identify all patients 65 or older undergoing primary hip arthroplasty. The results showed that CMS hip arthroplasty patients with an FNF had significantly higher rates of mortality, thromboembolic events, readmission, and greater direct cost. The authors concluded that reimbursement models for arthroplasty should account for different perioperative complication and resource utilization for FNF patients.
AHRQ-funded; HS024714.
Citation: DeKeyser GJ, Martin BI, Ko H .
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
J Arthroplasty 2022 Apr; 37(4):742-47.e2. doi: 10.1016/j.arth.2021.12.027..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare
Liao JM, Gupta A, Zhao Y
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
The purpose of this study was to examine and compare 2011-2017 spending for hip and joint replacements between hospitals with voluntary participation, mandatory participation and nonparticipation in the Medicare Bundled Payments for Care Improvement program.
Citation: Liao JM, Gupta A, Zhao Y .
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
JAMA 2021 Aug 3;326(5):438-40. doi: 10.1001/jama.2021.10046..
Keywords: Medicare, Hospitals, Payment, Surgery, Orthopedics, Healthcare Costs
Dekhne MS, Nuliyalu U, Schoenfeld AJ
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
This study examined “surprise” out-of-network billing in orthopedic surgery. Data was analyzed from the Clinformatics DataMart on commercial insured patients undergoing 4 different elective orthopedic procedures from 2012 to 2017: arthroscopic meniscal repair, lumbar discectomy, total knee replacement and total hip replacement. They defined surprise bills as out-of-network bills for procedures done at in-network hospitals. The rate of potential surprise bills was 24.8% for total knee replacement, 24.5% lumbar discectomy, 23.5% for total hip replacement, and 12.5% for meniscal repair. The largest number of surprise bills came from anesthesiologists (39% of all episodes), and durable medical equipment (15%). Per episode, the largest bills came from nonphysician surgical assistants, neurologists, and physician assistants.
AHRQ-funded; HS000053; HS023597.
Citation: Dekhne MS, Nuliyalu U, Schoenfeld AJ .
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
Ann Surg 2020 May;271(5):e116-e18. doi: 10.1097/sla.0000000000003825..
Keywords: Orthopedics, Surgery, Payment, Healthcare Costs, Health Insurance
Maeda JL, Mosher Henke R, Marder WD
AHRQ Author: Karaca Z, Friedman BS, Wong HS
Variation in hospital inpatient prices across small geographic areas.
The authors examined whether market competition may influence the difference in the inpatient price per discharge between public and private payers across small geographic areas. They found greater geographic variation in the inpatient price per discharge among private than public payers for most hospital services, while hospitals in more concentrated markets were associated with a higher price per discharge among knee arthroplasty discharges for both payers. They concluded that hospitals charged significantly higher prices to private than public payers.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Maeda JL, Mosher Henke R, Marder WD .
Variation in hospital inpatient prices across small geographic areas.
Am J Manag Care 2014 Nov;20(11):907-16.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Orthopedics, Surgery