A Nurse Navigator Program Is Effective in Reducing Episode-of-Care Costs Following Primary Hip and Knee Arthroplasty.
BACKGROUND
Alternative payment models for total hip arthroplasty (THA) and total knee arthroplasty (TKA) have incentivized providers to deliver higher quality care at a lower cost, prompting some institutions to develop formal nurse navigation programs (NNPs). The purpose of this study was to determine whether a NNP for primary THA and TKA resulted in decreased episode-of-care (EOC) costs.


METHODS
We reviewed a consecutive series of primary THA and TKA patients from 2015-2016 using claims data from the Centers for Medicare and Medicaid Services and Medicare Advantage patients from a private insurer. Three nurse navigators were hired to guide discharge disposition and home needs. Ninety-day EOC costs were collected before and after implementation of the NNP. To control for confounding variables, we performed a multivariate regression analysis to determine the independent effect of the NNP on EOC costs.


RESULTS
During the study period, 5275 patients underwent primary TKA or THA. When compared with patients in the prenavigator group, the NNP group had reduced 90-day EOC costs ($19,116 vs $20,418 for Medicare and $35,378 vs $36,961 for private payer, P < .001 and P < .012, respectively). Controlling for confounding variables in the multivariate analysis, the NNP resulted in a $1575 per Medicare patient (P < .001) and a $1819 per private payer patient cost reduction (P = .005). This translates to a cost savings of at least $5,556,600 per year.


CONCLUSION
The implementation of a NNP resulted in a marked reduction in EOC costs following primary THA and TKA. The cost savings significantly outweighs the added expense of the program. Providers participating in alternative payment models should consider using a NNP to provide quality arthroplasty care at a reduced cost.
['Phillips|Jessica L H|JLH|', 'Rondon|Alexander J|AJ|', 'Vannello|Chris|C|', 'Fillingham|Yale A|YA|', 'Austin|Matthew S|MS|', 'Courtney|P Maxwell|PM|']
D000368:Aged D019644:Arthroplasty, Replacement, Hip D019645:Arthroplasty, Replacement, Knee D014487:Centers for Medicare and Medicaid Services, U.S. D017050:Episode of Care D005260:Female D006801:Humans D008297:Male D006278:Medicare D062526:Patient Navigation D010359:Patient Readmission D012189:Retrospective Studies D014481:United States
nurse navigator costs total hip arthroplasty total knee arthroplasty bundled payments