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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_9 | Pages 68 - 68
1 Oct 2020
Illgen RL Springer BD Bozic KJ Sporer SM Huddleston JI Lewallen DG Porter K Browne JA
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Introduction

The American Joint Replacement Registry (AJRR) is the largest registry of total hip and knee arthroplasty (THA and TKA) procedures performed in the U.S. The National (Nationwide) Inpatient Sample (NIS) is a public database containing demographic estimates based on more than seven million hospitalizations annually. The purpose of this study was to analyze whether AJRR data is representative of the national experience with TJA as represented in NIS

Methods

Cohen's d effect sizes were computed to ascertain the magnitude of differences in demographics, hospital volume (in 50 patient increments), and geographic characteristics between the AJRR and NIS databases.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_9 | Pages 17 - 17
1 Oct 2020
Hooper J Lawson K Amanatullah D Hamad C Angibaud L Huddleston JI
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Introduction

Instability is a common reason for revision after total knee arthroplasty. A balanced flexion gap is likely to enhance stability throughout the arc of motion. This is achieved differently by the gap balancing and measured resection techniques. Given similar clinical results with the two techniques, one would expect similar rotation of the femoral component in the axial plane. We assessed posterior-stabilized femoral component axial rotation placed with computer navigation and a modified gap balancing technique. We hypothesized that there would be little variation in rotation.

Methods

90 surgeons from 8 countries used a modified gap-balancing technique and the same posterior-stabilized implant for this retrospective study. Axial rotation of the femoral component was collected from a navigation system and reported relative to the posterior condylar line. Patients were stratified by their preoperative coronal mechanical alignment (≥ 3° varus, < 3° varus to < 3° valgus, and ≥ 3° valgus).


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 41 - 41
1 Oct 2019
Iorio R Barnes CL Vitale M Huddleston JI Haas D
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Introduction

In November 2017, the Center for Medicare and Medicaid Services (CMS) finalized the 2018 Medicare Outpatient Prospective Payment System rule that removed total knee arthroplasty (TKA) procedures from the Medicare inpatient-only (IPO) list of procedures. This action had significant and unexpected consequences.

For several years, CMS has utilized a rule called the “Two-Midnight Rule” to define outpatient status for all procedures not on the IPO list. CMS made TKA subject to the “Two-Midnight Rule” in conjunction with the decision to move TKA off the IPO list. According to the “Two-Midnight Rule,” a hospital admission should be expected to span at least two midnights in order to be covered as an inpatient procedure. If it can be reliably expected that the patient will not require at least two midnights in the hospital, the “Two-Midnight Rule” suggests that the patient is considered an outpatient and is therefore subject to outpatient payment policies. Under prior guidance related to the “Two-Midnight Rule;” however, CMS also states that Medicare may treat some admissions spanning less than two midnights as inpatient procedures if the patient record contains documentation of medical need. The final rule was clear in stating CMS's expectation was that the great majority of TKAs would continue to be provided in an inpatient setting.

Methods

We looked at 3 different levels of the IPO rule impact on TKA for Medicare beneficiaries: a national comparison of fee for service (FFS) inpatient and outpatient classification for 2017 vs 2018; a survey of AAHKS surgeons completed in April of 2019; and an in-depth analysis of a large academic medical center experience. An analysis of change in inpatient classification of TKA patients over time, number of Quality Improvement Organization (QIO) audits, compliance solutions of organizations for the new rule and cost implications of those compliance solutions were evaluated.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 42 - 42
1 Oct 2019
Barnes CL Haas D Huddleston JI Iorio R
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Introduction

The Centers for Medicare and Medicaid Services (CMS) removed total knee arthroplasty (TKA) from inpatient-only status in 2018. Our goal was to measure the adoption of outpatient TKAs, the impact on re-treatment rates, and the economic implications for hospitals.

Methods

We utilized 100% national Medicare Part A fee-for-service (FFS) patient-level claims data for 2017–2018. We excluded DRG 469 TKAs since they are unlikely to be outpatient candidates, which left 257,107 primary TKAs in 2017 and 264,393 in 2018. We examined the time trend in monthly case volume and 30-day retreatment rate (defined as percent of patients having a second TKA within 30 days of the first. We calculated the loss in revenue for a hospital by multiplying the decrease in payment rate between inpatient and outpatient by the outpatient and total 2018 TKA volume.