Physical therapy before joint replacement surgery cut the predicted use of postoperative care by 29%, saving an estimated $1,215 in health care costs per patient, according to a Medicare claims analysis.
“These data are clinically relevant and can be used in the development of cost-effective and value-based total joint replacement programs,” said Dr. Richard Snow at OhioHealth in Columbus and his associates. The study is the first to evaluate the real-world link between preoperative physical therapy and use of postoperative care, the researchers said.
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Numbers of total hip and knee replacements are projected to increase by 1.7 and 6.7 times, respectively, in the United States between 2005 and 2030, Dr. Snow and his coauthors noted. And while average length of hospital stay after these surgeries has dropped by more than 50%, there has been a substantial rise in per-patient costs of skilled nursing facilities, home health agencies, and inpatient rehabilitation, they said (J. Bone Joint Surg. 2014 Oct. 1 [doi:10.2106/JBJS.M.01285]).
The researchers analyzed 4,733 hip and knee replacement cases within a 39-county cluster of Medicare referral hospitals, and looked at the association between preoperative physical therapy (or “prehabilitation”) and use of postoperative care services in the 90 days after hospital discharge. Because of the skewed distribution of payments, the investigators looked only at cases that fell below the 95th percentile (or $41,113) for cost of care, they said.
In all, 79.7% of patients who did not undergo prehabilitation used acute care services after surgery, compared with 54.2% of patients who did (P < .0001). After controlling for comorbidities and demographic variables, prehabilitation was linked to an absolute reduction of 29% from the predicted to the observed rate of post-acute care use, saving an estimated average of $1,215 per patient, they said. Reductions in use of skilled nursing facilities, home health care services, and inpatient rehabilitation were the main drivers of the cost reduction, the researchers reported.
The findings support prior work indicating that prehabilitation can improve the value of care for patients undergoing total joint replacements, said Dr. Snow and his associates. “As the volume of arthroplasties expands within the framework of increasing health care costs, providers are under mounting pressure to identify the most cost-effective method of delivering high-quality, value-based health care,” they said.
Future studies should look at optimal ways to balance preoperative and postoperative care in specific populations of patients, the investigators said.
The research was partially supported by OhioHealth Research Institute. One or more authors reported financial relationships with biomedical entities deemed to possibly influence the research.