A comparison of hospital length of stay versus the early transfer to a skilled nursing facility: the effect on direct costs of total joint arthroplasty

The direct costs of total joint arthroplasty are multifactorial. Third party payers, managed care organizations and hospital utilization review committees continue to monitor each surgeon’s cost profile in total joint arthroplasty. The length of stay in hospital and transfer to a skilled nursing facility (transitional care unit or nursing home) are considered to be major determinants in the direct costs of total joint arthroplasty. The direct costs hospitalization, transitional care unit and nursing home stay were analyzed for 971 primary total hip and knee arthroplasties performed in three hospitals in St. Paul, Minnesota between September 1992 and December 1993. Those patients who were discharged directly home with or without home healthcare had lower direct costs than those transfered to a transitional care unit or nursing home. Despite the emphasis on decreased length of stay for achieving cost containment, keeping the patient hospitalized for up to 7 days can result in lower total direct costs for total joint replacement compared to early transfer to a transitional care unit or nursing home.