March 28th, 2014Total Joint Replacements

Community Dialogue

1997 2011

Minnesota Health Action Group; confidential - do not copy or distribute without permission

2

33

International Landscape 26 countries, European countries plus Australia, New Zealand

and Canada, collect joint replacement data in national registries; some since 1975 to support quality improvement, track devices

Transparency - web based information in some countries for consumer decision support

NHS includes– Hospital reviews (similar to Yelp)– Hospital quality by type of surgery– Physician quality

• Mortality • Volume by type of surgery; hip, knee, primary, revisions• Reasons physicians don’t report

– Patient education – materials and videos on surgical procedure, patient experience, recovery

Minnesota Health Action Group; confidential - do not copy or distribute without permission3

44Minnesota Health Action Group; confidential - do not copy or distribute without permission

4

Knee replacements Hip replacements

FrequencyPer 100,000

U.S.

International Landscape – U.S. Compared to OECD

55

Trend in Selected OECD Countries 2000-2009

Minnesota Health Action Group; confidential - do not copy or distribute without permission5

Total Knee Replacements Total Hip Replacements

66

US Landscape Quality measures and registries evolving Provider initiatives

– Research on improvement • Function and Outcomes Research for

Comparative Effectiveness in TJR (FORCE TJR)

• High Value Healthcare Collaborative Employer initiatives besides MN Health Action Group

– CalPERS reference pricing– PBGH/ECEN – Walmart & Lowes COEs– BridgeHealth surgery networks – Alliance, Madison – QualityPath

Payer initiatives – Numerous CMS bundled payment initiatives– Numerous private payer bundled payment

initiatives Consumer Reports Safe Patient Project calling for

device warranties

Minnesota Health Action Group; confidential - do not copy or distribute without permission6

77

Minnesota Landscape High relative cost High relative volume – both hips & knees Little transparency in cost – CMS website

shows MN hospital allowed amounts range ~$23k to ~$55k (2.5 fold)

Little information about quality – CMS website for DRG 470

• MN complications mirrors US• Better than average patient

experience but high variation - 69% to 88%

– MNCM pilot for TKR delayed No local CMS bundled payment initiatives Private payer bundled payment emerging

recently

Minnesota Health Action Group; confidential - do not copy or distribute without permission7

88

Why Do Employers Care about TJRs? High and variable cost; primarily in hospitals and devices High and increasing frequency Complications - resulting in recalls

– Highlight device failures and uncertain longevity– Much more expensive than original surgery– Impact on productivity, functionality, increased costs

Baby boomer generation + obesity = even higher use TJR volume has doubled since 2003, TKR tripled for <65 Obesity a bigger driver for younger patients; 65% <65 Known effectiveness in short term; longer term outcomes

unknown

Minnesota Health Action Group; confidential - do not copy or distribute without permission8

99

AHIP (American Health Insurance Plans) Data

Minnesota Health Action Group; confidential - do not copy or distribute without permission9

Total Joint ReplacementsDRG 470