Effectiveness of a Model Bundle Payment Initiative for Femur Fracture Patients

Abstract

Objectives: To analyze the effectiveness of a Bundled Payment for Care Improvement (BPCI) initiative for patients who would be included in a future potential Surgical Hip and Femur Fracture Treatment bundle.

Design: Retrospective cohort.

Setting: Single Academic Institution.

Patients/participants: Patients discharged with operative fixation of a hip or femur fracture (Diagnosis-Related Group codes 480-482) between January 2015 and October 2016 were included. A BPCI initiative based on an established program for BPCI total joint arthroplasty was initiated for patients with hip and femur fractures in January 2016. Patients were divided into nonbundle (care before initiative) and bundle (care with initiative) cohorts.

Intervention: Application of BPCI principles.

Main outcome measures: Length of stay, location of discharge, and readmissions.

Results: One hundred sixteen patients participated in the "institutional bundle," and 126 received care before the initiative. There was a trend toward decreased mean length of stay (7.3 ± 6.3 days vs. 6.8 ± 4.0 days, P = 0.457) and decreased readmission within 90 days (22.2% vs. 18.1%, P = 0.426). The number of patients discharged home doubled (30.2% vs. 14.3%, P = 0.008). There was no difference in readmission rates in bundle versus nonbundle patients based on discharged home status; however, bundle patients discharged to a skilled nursing facility trended toward less readmissions than nonbundle patients discharged to a skilled nursing facility (37.3% vs. 50.6%, P = 0.402). Mean episode cost reduction due to initiative was estimated to be $6450 using Medicare reimbursement data.

Conclusion: This study demonstrates the potential success of a BPCI initiative at 1 institution in decreasing postacute care facility utilization and cost of care when used for a hip and femur fracture population.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.