Perioperative X-rays in arthroplasty surgery: outcome and cost

Numerous legislative proposals to cut reimbursement to surgeons and hospitals are presently included in U.S. congressional and senate agendas. Perioperative x-ray films in arthroplasty surgery are standard operating procedure. Our objective was to assess the effects of the radiologist reading on the clinical and economic outcome of arthroplasty procedures. One hundred consecutive cases were prospectively studied. The radiologist reading, clinical management, and outcome of each case were carefully reviewed. The amount billed for the radiologist interpretation was noted for each examination. A total of 398 studies in 100 patients were done. Ninety-six preoperative, 110 intraoperative, and 192 postoperative radiographic studies were reviewed. These reports took an average of 1.71 days to be recorded on the chart (SD +/- 2.45). The total radiologic professional fees billed to Medicare in these cases was $11,054. (The radiologist's interpretation was not useful in the clinical management and did not affect the outcome in any case.) Assuming that each surgeon takes 1 x-ray film on every arthroplasty case, the total actual savings to Medicare of not having a radiologist reading these studies could reach $536,000 per year; if 2 intrahospital x-ray studies are performed per procedure (preoperative, intraoperative, or postoperative), the savings are $1.1 million per year. These cost reductions are achieved at no sacrifice to quality of care or outcome. Numerous areas of excessive spending with no improvement in outcome exist in the treatment of Medicare patients. There areas should be identified and eliminated before surgical fees are lowered even further.