Date of Award

12-2016

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

First Advisor

Cindy Miller

Abstract

Background: Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) are two of the most successful procedures performed in orthopedics. The demand for these procedures is estimated to grow 174% for THAs and 673% for TKAs by 2030, which will have a valued bill of almost $50 billion for Medicare. The bundled payment plan is a way to reduce costs for these procedures, where an estimated 35% of the bill is related to post-discharge care (Schaeffer et al., 2015, p. 723).

Review of the Literature: In 2015, this healthcare reform began including readmission penalties for patients readmitted within 30 days post total knee arthroplasty (TKA) DRG 469 and total hip arthroplasty (THA) DRG 470. These postoperative TKA/THA readmissions include all-cause hospital-wide readmissions, linking payments to patient outcomes as developed by the Centers for Medicare and Medicaid Services (CMS) (Lavernia & Villa, 2015, p. 1127).

Purpose: The purpose of this MSN Thesis was to align the incentives of the hospital, the surgeons, and pre/post-acute care providers, with focused pre-operative education classes, screening appointments and one-on-one information sessions with positive patient outcomes and experiences. This research examined readmission rates and patient satisfaction scores before and after the implementation of the Orthopedic Nurse Navigator role.

Methods: This research was a quantitative descriptive study that was retrospective in nature and examined patients who underwent total hip replacement or total knee replacement and who were enrolled in CMS’s BPCI (Medicare or Medicaid) reimbursement program.

Results: During the period of time before the Orthopedic Navigator began providing preoperative education and support, the BPCI patients (n=202) experienced a readmission rate of 10.40% (n=21). After the Orthopedic Navigator began providing preoperative education and postoperative support, the BPCI patients (n=206) experienced a readmission rate of 8.74% (n=18). This change in readmission rates for BPCI patients is a 1.66% reduction. Additionally, after the Orthopedic Navigator began, patient satisfaction scores for “Likelihood to Recommend” were measured for five months, from May 1, 2016 and ending September 30, 2016. These scores improved by 8.16 percentage points.

Conclusion: While the readmission rate reduction was not statistically significant, the reduction created a positive outcome for patients and reimbursement, creating value for the patients, hospital and orthopedic navigator program. The increase in patient satisfaction scores also indicates value for the navigator program and improved patient “likelihood to recommend”.

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