The Hip and Femur Fracture Bundle: Preliminary Findings from a Tertiary Hospital.

BACKGROUND: The voluntary hip and femur fracture Bundled Payments for Care Improvement Advanced (BCPI-A) includes Diagnosis Related Groups (DRG) 480, 481, and 482, which include diverse and medically complex patients undergoing urgent inpatient surgery without optimization. Concern exists that this bundle is financially unfavorable for hospitals, and this study aimed to identify the costliest services.

METHODS: We retrospectively reviewed a 12-month cohort of 32 consecutive patients in the DRG 480-482 bundle at our academic tertiary referral center. Cost of discharge disposition, readmission, and other variables were analyzed for all patients in the 90-day bundle.

RESULTS: Overall, a net financial gain averaging $2,028 per patient (range -$52,128 to +$30,199) was seen. Discharge to facilities (n=19) resulted in higher costs than discharge to home (n=11, p<.0001). Use of inpatient rehabilitation (n=6) averaged a loss of $11,028 per patient and use of skilled nursing facilities (n=15) averaged a loss of $7,250 per patient, compared to a gain of $15,011 for patients discharged home (n=11). Episodes with readmission (n=6) averaged a loss of only $1,390. Total index admission costs averaged $12,489 +/- $2235 per patient (range $9,329 - $18,884) while post-inpatient cost averaged $30,150 per patient (range $4,803 - $77,768).

CONCLUSION: The BPCI-A hip and femur fracture bundle has a wide variability in costs, with the largest component in the post-acute care phase. Discharge home is favorable in the bundle while discharge to post-acute facilities leads to net losses. Institutions in this bundle need to develop multi-disciplinary teams to promote safe discharge home.