Total Knee Replacement: Cutting Costs without Cutting CareTotal knee replacement is a popular kind of surgery--and for good reason. This surgery successfully relieves pain and improves function in arthritic knees. From 1999 to 2000, the number of knee replacements went up by 23 percent. As the United States population gets older, the demand for this surgery will continue to grow.
The cost of knee replacement is also on the rise. This is a problem for the federal government, which pays for about two-thirds of all knee replacements through the Medicare program. Is there a way to reduce the cost of knee replacement without compromising patient care?
These authors thought so. They looked at the effects of a two-part cost-reduction program. First, the authors set a clinical pathway, or standardized routine of care, to take patients from surgery to rehabilitation. The pathway was designed to improve care, reduce hospital stays, and reduce hospital costs.
Second, a program was started to reduce the money spent on knee implants. Under the new program, implant selection was based on the amount of stress patients were likely to put on their new knees. This was decided on the basis of patient age, weight, activity, and health. Patients who were likely to put a lot of stress on implants could have a variety of implants, including more expensive models. Patients who were likely to put less stress on implants got less expensive models that worked just as well.
Patients who had knee replacements with the new cost-reduction programs were compared to those who had knee replacements before these programs were in place. Five to eight years after surgery, there were no differences in the results of the two groups. Both groups had excellent relief from pain. They had more knee movement and were better able to do activities. Both groups were very satisfied with treatment. Neither group was more likely to need more surgery or medical care.
The quality of patient care stayed the same, even though the cost of the procedure (adjusted for inflation) went down 19 percent. This was due to the fact that patients spent only four days in the hospital with the cost-reduction program, versus seven days before the program started. Patients were able to spend less time in the hospital after surgery because they were discharged to rehabilitation facilities. Costs were also reduced with the use of less expensive implants called "all-polyethylene tibial implants."
The authors feel that the cost of total knee replacement can be reduced while maintaining excellent standards of care. Orthopedic surgeons will continue to put patients first, even under pressure to cut medical costs.
William L. Healy, MD, et al. Impact of Cost Reduction Programs on Short-Term Patient Outcome and Hospital Cost of Total Knee Arthroplasty. In Journal of Bone and Joint Surgery. March 2002. Vol. 84-A. No. 3. Pp. 348-353.
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