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Updated: Nov 6, 2025
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Understanding the Value of Total Shoulder Arthroplasties at Physician-Owned Hospitals
Azeem Tariq Malik1, Mathangi J Sridharan, Julie Y Bishop
1From the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
Insights
Total shoulder arthroplasties (TSAs) at physician-owned hospitals (POHs) show similar clinical outcomes to non-POHs, except for higher stiffness rates. However, TSAs at POHs demonstrate significantly lower costs, warranting further value assessment.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Healthcare Economics
Background:
- Physician-owned hospitals (POHs) face scrutiny over cost, quality, and patient selection.
- The Affordable Care Act restricted new POH formation.
- Rising utilization of total shoulder arthroplasties (TSAs) necessitates evaluating TSA quality and cost at POHs.
Purpose of the Study:
- To compare the quality and cost of TSAs performed at POHs versus non-POHs.
- To assess patient outcomes and healthcare charges associated with TSAs in different hospital types.
Main Methods:
- Analysis of Medicare 100% Standard Analytical Files (2011-2014).
- Inclusion of patients undergoing anatomic or reverse TSA at POHs and non-POHs.
- Multivariate regression analyses to compare 90-day and 1-year outcomes and costs.
Main Results:
- No significant differences in major complications (infections, dislocations, fractures, PE, DVT, AMI, sepsis) between POHs and non-POHs.
- Higher odds of postoperative stiffness at 90 days (OR 1.39) and 1 year (OR 1.51) for TSAs at POHs.
- Significantly lower risk-adjusted 90-day charges (-$8,904) and costs (-$1,659) for TSAs at POHs.
Conclusions:
- TSAs at POHs yield comparable clinical outcomes to non-POHs, with slightly increased stiffness.
- POHs demonstrate lower healthcare costs for TSAs.
- Further research is recommended to evaluate the overall value of care provided by POHs for TSAs.
Background:
Owing to concerns regarding higher cost, low quality of care and cherry-picking in physician-owned hospitals (POHs), the Affordable Care Act imposed sanctions that prevented the formation of new POHs. With an increasing utilization of total shoulder arthroplasties (TSAs), there is a need for re-evaluation and assessment of quality and cost of TSAs performed at these POHs.
Methods:
The 2011 to 2014 Medicare 100% Standard Analytical Files was used to identify patients undergoing a reverse TSA or anatomic TSA at POHs and non-POHs. Multivariate regression analyses were used to assess differences in 90-day and 1-year outcomes between the two groups.
Results:
A total of 1,626 (2.2%) patients received a TSA at a POH (N = 50). No notable differences were noted between POH versus non-POHs regarding 90-day surgical site infections (P = 0.645), dislocation (P = 0.068), periprosthetic fractures (P = 0.556), revision arthroplasty (P = 0.114), pulmonary embolism (P = 0.155), deep vein thrombosis (P = 0.208), acute myocardial infarction (P = 0.219), sepsis (P = 0.288), urinary tract infections (P = 0.186), all-cause readmissions (P = 0.427), 1-year dislocations (P = 0.475), 1-year periprosthetic fractures (P = 0.697), and 1-year revision arthroplasties (P = 0.225). TSAs performed at POHs had higher odds of postoperative stiffness at 90-day (odds ratio 1.39; P < 0.001) and 1-year follow-up points (odds ratio 1.51; P < 0.001). TSAs at POHs had markedly lower risk-adjusted 90-day charges (-$8,904) and 90-day costs (-$1,659).
Conclusion:
Apart from slightly higher rates of stiffness and renal complications, patients undergoing TSAs at POHs seem to have similar outcomes as compared to non-POHs, while having lower costs of care. The findings suggest a need for further research, evaluating the value of care at POHs.
Level Of Evidence:
Level III.
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