March 28 th , 2014 Total Joint Replacements
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Transcript of March 28 th , 2014 Total Joint Replacements
March 28th, 2014Total Joint Replacements
Community Dialogue
1997 2011
Minnesota Health Action Group; confidential - do not copy or distribute without permission
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International Landscape 26 countries, European countries plus Australia, New Zealand
and Canada, collect joint replacement data in national registries; some since 1975 to support quality improvement, track devices
Transparency - web based information in some countries for consumer decision support
NHS includes– Hospital reviews (similar to Yelp)– Hospital quality by type of surgery– Physician quality
• Mortality • Volume by type of surgery; hip, knee, primary, revisions• Reasons physicians don’t report
– Patient education – materials and videos on surgical procedure, patient experience, recovery
Minnesota Health Action Group; confidential - do not copy or distribute without permission3
44Minnesota Health Action Group; confidential - do not copy or distribute without permission
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Knee replacements Hip replacements
FrequencyPer 100,000
U.S.
International Landscape – U.S. Compared to OECD
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Trend in Selected OECD Countries 2000-2009
Minnesota Health Action Group; confidential - do not copy or distribute without permission5
Total Knee Replacements Total Hip Replacements
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US Landscape Quality measures and registries evolving Provider initiatives
– Research on improvement • Function and Outcomes Research for
Comparative Effectiveness in TJR (FORCE TJR)
• High Value Healthcare Collaborative Employer initiatives besides MN Health Action Group
– CalPERS reference pricing– PBGH/ECEN – Walmart & Lowes COEs– BridgeHealth surgery networks – Alliance, Madison – QualityPath
Payer initiatives – Numerous CMS bundled payment initiatives– Numerous private payer bundled payment
initiatives Consumer Reports Safe Patient Project calling for
device warranties
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Minnesota Landscape High relative cost High relative volume – both hips & knees Little transparency in cost – CMS website
shows MN hospital allowed amounts range ~$23k to ~$55k (2.5 fold)
Little information about quality – CMS website for DRG 470
• MN complications mirrors US• Better than average patient
experience but high variation - 69% to 88%
– MNCM pilot for TKR delayed No local CMS bundled payment initiatives Private payer bundled payment emerging
recently
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Why Do Employers Care about TJRs? High and variable cost; primarily in hospitals and devices High and increasing frequency Complications - resulting in recalls
– Highlight device failures and uncertain longevity– Much more expensive than original surgery– Impact on productivity, functionality, increased costs
Baby boomer generation + obesity = even higher use TJR volume has doubled since 2003, TKR tripled for <65 Obesity a bigger driver for younger patients; 65% <65 Known effectiveness in short term; longer term outcomes
unknown
Minnesota Health Action Group; confidential - do not copy or distribute without permission8
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AHIP (American Health Insurance Plans) Data
Minnesota Health Action Group; confidential - do not copy or distribute without permission9
Total Joint ReplacementsDRG 470