Published 4/1/2014

Second Look—Advocacy

Cost variations in hip, knee arthroplasty
According to the National Institute for Health Care Reform, hospital inpatient price differences account for most of the spending variation on “episodes of care” rather than differences in spending on physician and other nonhospital services during and after discharge or spending on readmissions. Researchers found wide variation across institutions in the cost for hip and knee arthroplasty, with total spending for such procedures ranging from $17,000 to more than $35,000.

Physicians shifting to hospital employment
An article in The New York Times looks at the ongoing shift in employment patterns as physicians transition from private practices to hospital employment. Data from the placement firm Merritt Hawkins show that 64 percent of job offers filled through that company during 2013 involved hospital employment, compared with only 11 percent in 2004. The firm expects the proportion of hospital offers to increase to 75 percent over the next 2 years.

A quarter of complications occur after discharge
Data from a study published online in JAMA Surgery suggest that hospital discharge may be an insufficient end point for quality assessment based on readmissions. The retrospective cohort study of 59,273 surgical procedures performed at 112 Department of Veterans Affairs hospitals found an overall complication rate of 22.6 percent (71.9 percent predischarge complications, 28.1 percent postdischarge complications). The overall 30-day readmission rate was 11.9 percent, and although 56.0 percent of readmissions were associated with a currently assessed complication, more than one quarter of assessed complications were diagnosed after hospital discharge. In addition, the proportion of postdischarge complications varied significantly based on type of complication, with surgical site infection accounting for 55.7 percent overall.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)