6 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 6
Post-surgical care of joint replacement patients is
rapidly changing, with more rehab taking place at
home and at the physical therapist's rather than at
costly inpatient rehab facilities or nursing homes.
Surgical facilities didn't pay nearly as much
attention to where joint replacement patients
rehabbed before the advent of bundled payments,
which pay facilities for an episode of care that
begins before surgery and ends 30 to 90 days after.
Providers share in savings if they bring expenses
down. A typical stay in a nursing home after surgery
can cost up to $15,000, nearly 4 times as much as
an average home-care episode ($3,500) and a course
of outpatient physical therapy ($700). Plus, studies
have shown that joint replacement patients do no
better with physical therapy than with daily activity.
Increasingly, inpatient rehab is reserved for the
elderly with other medical problems, and for
patients who don't have a good support system at home. Matthew S. Austin, MD, director of joint
replacement services at the Rothman Institute at Thomas Jefferson University Hospital in
Philadelphia, is among those who believe that you don't need to have a rigidly structured rehab
program after joint replacement.
At Rothman, healthy, active total joint patients may choose to be in charge of their own thera-
py, using a computer program called Force Therapeutics, which guides them through exercises
and tracks both compliance and pain. It's not for everybody, but the economic impact of the
self-therapy route is significant.
"Post-discharge care can occupy a significant amount of the total cost of joint replacement —
in some case up to 50%," says Dr. Austin. "We're trying to appropriately utilize services."
PHYSICAL THERAPY
The Changing Post-Surgical Rehab Landscape
• ADDED EXPENSE Post-surgical rehab has
become a target for cuts, with more patients being
sent straight home after joint replacement, where
they can get in-home nursing visits and go to outpa-
tient physical therapy.
