Acute Femoral Neck Fracture

Femoral neck fractures are a worldwide epidemic. However, the incidence of these fractures and mortality associated with them have declined owing to improvements in preventive medicine. Nevertheless, most comorbidities among these patients have increased. The cost to society for treating these fractures is staggering. Managing these fractures cost-effectively with good outcomes and minimal complications—for individual patients as well as health care delivery systems—is paramount. Alternative payment models are now prevalent in the United States, with Centers for Medicare Services now including hip fractures in Comprehensive Care for Joint Replacement (CJR) and Bundled Care Payment Initiative (BCPI) models for global episodes of care in an attempt to decrease costs and drive efficient pathway models.

A number of studies report successful implementation of alternative care models. Froemke's group recently reported on their experience developing and initiating a bundled payment project within a hospital system that resulted in decreased length of stay (LOS) and increased discharge to home. Iorio's group reported midterm results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty and demonstrated decreased LOS, discharge to inpatient facilities, readmissions, and cost of the episode of care in year 3 compared with year 1. Overall, the program increased value to all stakeholders involved in the initiative, suggesting that continued improvement over initial gains is possible. Another BCPI study revealed that groups with well-defined clinical pathways had decreased LOS, better discharge disposition (generally to home), and decreased costs compared to groups that did not have clearly defined pathways. Importantly, these new alternative care models demonstrate improvements in care by outcomes while also decreasing the cost of this care.