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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Not all primary total hip arthroplasties are equal-so is there a difference in reimbursement?
Nipun Sodhi1, Sarah E Dalton2, Luke J Garbarino3
1Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
Insights
Orthopaedic surgeons are reimbursed less per minute for complex conversion total hip arthroplasties (THAs) compared to primary THAs, despite longer operative times. This analysis highlights potential financial disparities in physician reimbursement models for hip replacement procedures.
Area of Science:
- Orthopaedic Surgery
- Health Economics
- Physician Reimbursement
Background:
- Relative Value Units (RVUs) form the basis of physician reimbursement, reflecting the effort and value of medical procedures.
- Conversion total hip arthroplasties (THAs) are known to be more complex and time-consuming than primary THAs.
- Current RVU compensation may not adequately reflect the increased surgical time and complexity of conversion THAs.
Purpose of the Study:
- To compare operative times, RVUs, and RVU/minute for primary and conversion THAs.
- To analyze the financial implications of reimbursement differences between primary and conversion THAs for surgeons.
Main Methods:
- Analysis of 103,702 primary THA (CPT code 27130) and 2,986 conversion THA (CPT code 27132) cases from the National Surgical Quality Improvement Program (NSQIP) database.
- Calculation and comparison of mean operative times (minutes), mean RVUs, and mean RVU per minute.
- Performance of an annualized cost difference analysis based on reimbursement and operative time.
Main Results:
- Conversion THAs had significantly longer operative times (146 minutes) compared to primary THAs (94 minutes) (P<0.001).
- Mean RVUs were higher for conversion THAs (25.68) versus primary THAs (21.24) (P<0.001).
- Mean RVU per minute was significantly lower for conversion THAs (0.21) compared to primary THAs (0.26) (P<0.001), indicating lower reimbursement efficiency.
- An annualized cost analysis suggested a potential $173,529 difference favoring primary THAs.
Conclusions:
- Despite greater complexity and operative time, conversion THAs yield a lower RVU per minute reimbursement compared to primary THAs.
- Orthopaedic surgeons may be financially incentivized to prioritize primary THAs over conversion THAs based on current reimbursement structures.
- This data can inform practice management strategies for orthopaedic surgeons to optimize financial returns relative to surgical time invested.
Background:
Relative value units (RVUs) are a physician reimbursement model based on the effort required, or value, in providing a procedure or service for a patient. Procedures such as conversion total hip arthroplasties (THAs) can be compared to primary THAs, but many studies have revealed increased difficulties in conversion cases. Despite the increased time and effort for conversion THA, it is unknown if this is reflected in the RVU compensation model. Therefore, the purpose of this study was to compare the: (I) mean operative times; (II) mean RVUs; (III) RVU/minute for primary and conversion THAs; and (IV) perform an individualized idealized surgeon annual cost difference analysis.
Methods:
A total of 103,702 primary THA patients were identified using CPT code 27130 and 2,986 conversion THA patients were identified using CPT code 27132 using the National Surgical Quality Improvement Program (NSQIP) database. The mean RVUs, operative times (minutes), and RVU/minute were calculated and compared. An annualize cost analysis of dollar amounts per case, day, and the year was also performed.
Results:
The mean operative times for the primary and conversion THA cohorts were 94 vs. 146 minutes (P<0.001) and mean RVUs were 21.24 vs. 25.68 (P<0.001). Interestingly, the mean RVU per minute was higher for the primary THA compared to the conversion THA groups (0.26 vs. 0.21, P<0.001). Annualized cost analysis revealed a potential $173,529 difference from performing primary vs. conversion THAs.
Conclusions:
Even though conversion THA can be considered to a more complex and demanding procedure, based on RVUs per minute of surgery, orthopaedic surgeons are reimbursed better for primary THA cases. This data could be used by orthopaedic surgeons to administer their practices better to yield the highest return on time.
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