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J Hosp Adm. 2013;2(4). doi: 10.5430/jha.v2n4p71.

Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery.

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  • 1Department of Medicine, University of California, Los Angeles, CA, USA.
  • 2Merck Inc., Kenilworth, NJ, USA.
  • 3Department of Orthopedic Surgery, University of California, Los Angeles, CA, USA.



To examine change in regional variations in acute care length of stay (LOS) after orthopedic surgery following expiration of the New York (NY) State exemption to the Prospective Payment System and implementation of the Medicare Short Stay Transfer Policy.


Time series analyses were conducted to evaluate change in LOS across regions after policy implementations. Small area analyses were conducted to examine residual variation in LOS. The dataset included A 100% sample of fee-for-service Medicare patients undergoing surgical repair for hip fracture or elective joint replacement surgery between 1996 and 2001. Data files from Centers for Medicare and Medicaid Services 1996-2001 Medicare Provider Analysis and Review file, 1999 Provider of Service file, and data from the 2000 United States Census were used for analysis.


In 1996, LOS in NY after orthopedic procedures was much longer than the remainder of the country. After policy changes, LOS fell. However, significant residual variation in LOS persisted. This residual variation was likely partly explained by differences variation in regional managed care market penetration, patient management practices and unmeasured characteristics associated with the hospital location.


NY hospitals responded to changes in reimbursement policy, reducing variation in LOS. However, even after 5 years of financial pressure to constrain costs, other factors still have a strong impact on delivery of patient care.


Geographic/Spatial factors/Small area variations; Medicare; Small Area Analysis; Surgery

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