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Abstract
Hip osteoarthritis is a common form of osteoarthritis causing work disability. Total hip arthroplasty (THA) is the treatment for hip osteoarthritis when primary treatments fail. THA is associated with a high cost, success, and improved quality of life and its utilization is exponentiating worldwide. The bundled payment program under Medicare was cost-effective and reduced the remission risk and readmission rate for patients over 64 years old undergoing THA. Some hospitals and insurers attempted to implement commercial bundled payment for THA. The research investigating the effectiveness of the commercial bundled payment failed due to managerial and legal barriers, and low data availability. In this study, I hypothesized that the working-age patients undergoing THA under commercial bundled payment have lower unplanned readmission risk and unplanned readmission rate than those under non-bundled payment. Additionally, I hypothesized that the commercial bundled payment for working-age patients undergoing THA provides more days between THA and readmission, and it is more cost-effective compared to those under non-bundled payment. The unplanned readmission risk after THA among working-age patients using commercial bundled payment and non-bundled payment was examined by unadjusted and adjusted logistic regression followed by two propensity score matching analyses: nearest neighborhood matching and inverse probability weighted analysis. I compared the post-THA rate and rate ratio of unplanned readmission among working-age patients between bundled and non-bundled payment groups using negative binomial regression followed by marginal effect analysis. The association of commercial bundled payment on the count of days and the total cost between unplanned readmission compared to non-bundled payment was analyzed by unadjusted and adjusted regression analyses, followed by an incremental cost-effectiveness ratio analysis. I downloaded the data for this study from the electronic health record system of OrthoCarolina. A total of 2774 working-age patients had THA within the specified period and were included in the study. I found that the risk of unplanned readmission after THA among working-age patients was lower (Unadjusted:4%, Adjusted:10%) in the bundled payment group compared to the non-bundled payment group. The rate ratio for unplanned readmission in the commercial bundled payment group was 19% and 24% lower in unadjusted and adjusted analyses respectively, compared to the non-bundled payment group. However, due to the small sample size, the result failed to achieve statistical significance. The bundled payment group got more days between THA and unplanned readmission (unadjusted: 18.55, SE=11.6, P-value=0.110 and unadjusted: 12.87, SE=12.99, P-value=0.322) and was associated with higher costs compared to the non-bundled payment group. Even though the bundled payment was costlier, it was more effective than the non-bundled payment group. This study highlights the importance of commercial bundled payment programs. It may encourage policymakers to reevaluate and possibly expand the use of commercial bundled payments for working-age patients undergoing THA. Revising contractual agreements to include healthcare supplies within this coordinated care model could lower costs.