Shauver Melissa J, Yin Huiying, Banerjee Mousumi, Chung Kevin C
Section of Plastic Surgery and the Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan Health Systemth, Ann Arbor, MI 48109-0340, USA.
J Hand Surg Am. 2011 Aug;36(8):1282-7. doi: 10.1016/j.jhsa.2011.05.017. Epub 2011 Jun 25.
Distal radius fractures (DRFs) are the second most common fracture experienced by elderly individuals. In 2005, 16% of DRFs in the Medicare population were being treated with internal fixation, up from 3% in 1997. This shift in treatment strategy can have substantial financial impact on Medicare and the health care system in general. The specific aims of this project were to quantify the current and future Medicare expenditures attributable to DRF and to compare Medicare payments for the 4 treatment options for elderly DRF.
We analyzed the 100% 2007 Medicare dataset for annual DRF-attributable spending. Payments were obtained for claims that were identified as attributable to DRF by International Classification of Diseases, 9th Revision, Clinical Modification codes for DRF in conjunction with a Current Procedural Technology code for relevant treatment or service. We projected annual payments based on increasing internal fixation treatment. All payments are reported in 2007 U.S. dollars.
In 2007, Medicare made $170 million in DRF-attributable payments. If the usage of internal fixation were to reach 50%, DRF-attributable payments could be nearly $240 million. The mean attributable payment made for each patient in 2007 was $1,983. Most of this is due to facility and staffing cost for the treatment procedure.
This analysis provides an accurate quantification of Medicare DRF-attributable expenditure. Use of 100% Medicare data allows for the summation of actual patient experience rather than modeling or estimation. The burden of DRF is going to grow as the U.S. population ages and as internal fixation becomes more widely used. The Medicare payment data can help in allocating resources nationally to address the increasing disease burden of DRF.
桡骨远端骨折（DRF）是老年人第二常见的骨折类型。2005年，医疗保险人群中16%的桡骨远端骨折采用内固定治疗，而1997年这一比例为3%。这种治疗策略的转变可能会对医疗保险以及整个医疗保健系统产生重大财务影响。本项目的具体目标是量化当前及未来医疗保险因桡骨远端骨折产生的支出，并比较医疗保险为老年桡骨远端骨折患者的四种治疗方案所支付的费用。
我们分析了2007年100%的医疗保险数据集，以获取每年因桡骨远端骨折产生的支出。通过国际疾病分类第九版临床修订本中桡骨远端骨折的编码，结合相关治疗或服务的现行程序技术编码，确定可归因于桡骨远端骨折的索赔支付。我们根据内固定治疗使用量的增加预测年度支付情况。所有支付均以2007年美元报告。
2007年，医疗保险因桡骨远端骨折支付了1.7亿美元。如果内固定的使用率达到50%，因桡骨远端骨折产生的支付可能接近2.4亿美元。2007年每位患者的平均支付金额为1983美元。这主要是由于治疗过程中的设施和人员成本。
该分析准确量化了医疗保险因桡骨远端骨折产生的支出。使用100%的医疗保险数据能够汇总实际患者的情况，而非进行建模或估算。随着美国人口老龄化以及内固定的使用越来越广泛，桡骨远端骨折的负担将会增加。医疗保险支付数据有助于在全国范围内分配资源，以应对桡骨远端骨折日益增加的疾病负担。
