New study identifies 60,000 hospital days can be saved through changes to rehabilitation

A new Medibank/KPMG study published in today’s Medical Journal of Australia has found the Australian private healthcare system could free up 60,000 hospital days for other patients if in-hospital rehabilitation rates were reduced for people having total knee replacements.

The study assessed 35,000 total knee replacements (TKR) admissions in Australian private hospitals, finding large variation in the proportion of patients receiving in-hospital rehabilitation post -surgery, ranging from 0 to 100% by hospital. Since 2010, Australian private hospitals have seen an almost 50% increase in the use of in-hospital rehabilitation after TKR surgery.

Report author Dr Chris Schilling, KPMG Health Economist said: “Variation can be due to different health needs of patients, however when adjusted for patient characteristics – such as age, clinical profile and how the surgery went - the large variation in inpatient rehabilitation rates across hospitals persisted, suggesting that some in-hospital rehabilitation is low value care.”

The study outlined that the current funding model for hospitals encourages inpatient rehabilitation, but from a system perspective, this may not be optimal. For many patients, the same outcomes can be delivered by rehabilitation in the home and community-based settings, but at a much lower cost.

Dr Schilling said: “If inpatient rehabilitation rates were reduced to 31% (the rate in 2009) the private health system could save $50 million per year and make almost 60,000 hospital days available to other patients. There is a significant opportunity to reduce in-hospital rehabilitation rates, without having any detrimental effect on health outcomes. To ensure the sustainability and affordability of the healthcare system, it is important that every dollar is invested in high-value care.”

Medibank Chief Medical Officer Dr Linda Swan said the large increase in inpatient rehabilitation rates after TKR in the Australian private health system is in contrast to international trends, showing inpatient rehabilitation rates are decreasing as community and home based rehabilitation becomes more popular.

“There is strong clinical evidence that home and community-based rehabilitation delivers the same health outcomes as rehabilitation in the hospital for the majority of patients,” said Dr Swan.

This new study is supported by a 2018 report by the Royal Australasian College of Surgeons (RACS), which outlined the international trend of reducing in the number of patients who are referred for inpatient rehabilitation after TKR, with an increasing trend towards rehabilitation in the home.

Australian public hospital inpatient rehabilitation rates after TKR are currently at 17% with the report citing that Australia’s current private inpatient rehabilitation rate is 45%.

Australia has one of the world’s highest rates of TKR’s with over 50,000 surgeries performed during 2016, with approximately 70% delivered in the private healthcare setting.