Drivers of Episode-of-Care Costs in Total Knee Arthroplasty

Abstract

Alternative payment models, such as bundled payments, have grown in popularity to align incentives among providers to provide quality care at a reduced cost. Early data demonstrated success at reducing post-acute care resources and episode-of-care costs in total knee arthroplasty (TKA), but concerns regarding target price methodology and lack of appropriate risk-adjustment may limit the future of these bundled payment programs. This review will address specific drivers of episode-of-care costs in TKA. Modifiable medical comorbidities such as uncontrolled diabetes and malnutrition can be optimized prior to elective TKA. Minimizing in-hospital medical complications and unplanned ICU admissions can help drive down inpatient TKA costs. Finally, reducing rates of home health and discharge to skilled nursing facilities has the highest impact of episode-of-care cost reduction following TKA.