ESTIMATING HOSPITAL COSTS FOR BUPIVACAINE LIPOSOMAL INJECTABLE SUSPENSION IN MEDICARE PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY USING PREMIER CHARGEMASTER DATA

Hospitals in the Medicare Comprehensive Care for Joint Replacement (CJR) bundled payment program for TKA will need to improve quality and reduce costs to remain competitive. Studies suggest that using BLIS to manage postsurgical pain may impact perioperative outcomes such as length of stay (LOS) and home discharge but concerns have been expressed about its cost. This study examined hospital charges and costs for BLIS and TKA among Medicare patients. Hospital chargemaster data from the Premier Database was analyzed to determine charges and costs for BLIS, as well as the proportion of total hospital charges and costs for primary TKA (ICD-9 procedure 81.54) attributable to BLIS. This analysis focused on the five hospitals with the highest use of BLIS from 2013 to 2015 and included controls without BLIS from the same hospitals to minimize heterogeneity when comparing charges and costs at different hospitals. Costs were estimated by Premier using hospital-specific and item-specific charge to cost ratios. The analysis identified 3,359 TKA Medicare patients who received BLIS and 5,785 controls. Mean hospital charges for BLIS at the five hospitals were $1,094 while mean costs for BLIS estimated by Premier were $403, resulting in a mean charge to cost ratio for BLIS of 2.71. The cost of BLIS estimated by Premier exceeded the highest average wholesale price during the study period ($300) by 34%. Nevertheless, BLIS represented only 2.5% of total costs for TKA and patients who received BLIS had total hospital costs that were $823 lower than controls. Hospital chargemaster data from Premier identified wide variations in charges and costs for both TKA and BLIS, which accounted for a very small proportion of total costs. Despite the cost of BLIS, total hospital costs for TKA were lower for patients receiving BLIS than controls.