Hooper Rachel C, Sterbenz Jennifer M, Zhong Lin, Chung Kevin C
Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, MI.
Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, MI.
J Hand Surg Am. 2019 Jun;44(6):443-453. doi: 10.1016/j.jhsa.2019.02.019. Epub 2019 Apr 17.
To examine physician and hospital reimbursement for digit and thumb replantation compared with revision amputation.
Using the 2009-2016 Truven Health MarketScan Research Databases, we identified patients with a digit or thumb amputation. Following application of our inclusion and exclusion criteria, we divided patients into replantation and revision amputation groups. We extracted the mean physician and hospital reimbursement associated with each patient encounter. For comparison, we examined the work Relative Value Unit (wRVU) and Medicare Physician Fee Schedule (MPFS) for the respective procedures in addition to several common hand surgery procedures.
We identified 51,716 patients. Following application of our inclusion and exclusion criteria, 219 replantation and 6,209 revision amputation patients were included in our analysis. For replantation, the mean physician and hospital reimbursements ranged from $3,938 to $7,753 and $30,683 to $56,256, respectively. For revision amputation, the mean physician and hospital reimbursements ranged from $1,030 to $1,206 and $2,877 to $4,188, respectively. On multivariable analysis, hospitals performing replantation earned $37,788 more per case compared with revision amputation. Using the wRVU and MPFS data, we determined that replantation reimburses at $78/wRVU compared with higher earnings for revision amputation ($108), carpal tunnel release ($101), cubital tunnel release ($97), trigger finger release ($116), open reduction and internal fixation (ORIF) distal radius fracture ($87), flexor tendon repair ($98), extensor tendon repair ($122), repair of digital nerve ($89), and ORIF articular fracture ($82), respectively.
Low physician reimbursement for replantation compared with less complex hand procedures makes it difficult to recruit and retain hand surgeons for this purpose. By understanding the wRVU and MPFS system, hand surgeons and professional societies can explore ways to promote change in the way replantation is valued by the Centers for Medicare and Medicaid Services (CMS) as well as by hospital administrators.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/Decision Analysis III.
比较手指和拇指再植与截肢修复手术中医师和医院的报销情况。
利用2009 - 2016年Truven Health MarketScan研究数据库，我们识别出手指或拇指截肢患者。在应用我们的纳入和排除标准后，我们将患者分为再植组和截肢修复组。我们提取了与每位患者每次就诊相关的医师和医院报销均值。为作比较，除了几种常见的手部手术外，我们还研究了各自手术的工作相对价值单位（wRVU）和医疗保险医师费率表（MPFS）。
我们识别出51716例患者。在应用我们的纳入和排除标准后，219例再植患者和6209例截肢修复患者纳入我们的分析。对于再植手术，医师和医院报销均值分别为3938美元至7753美元以及30683美元至56256美元。对于截肢修复手术，医师和医院报销均值分别为1030美元至1206美元以及2877美元至4188美元。在多变量分析中，进行再植手术的医院每例比截肢修复手术多赚37788美元。利用wRVU和MPFS数据，我们确定再植手术每wRVU报销78美元，相比之下，截肢修复手术（108美元）、腕管松解术（101美元）、肘管松解术（97美元）、扳机指松解术（116美元）、桡骨远端骨折切开复位内固定术（ORIF，87美元）、屈肌腱修复术（98美元）、伸肌腱修复术（122美元）、指神经修复术（89美元）以及关节骨折ORIF（82美元）收益更高。
与不太复杂的手部手术相比，再植手术中医师报销费用较低，这使得难以招募和留住从事该手术的手外科医生。通过了解wRVU和MPFS系统，手外科医生和专业协会可以探索促进医疗保险和医疗补助服务中心（CMS）以及医院管理人员对手部再植手术估值方式改变的方法。
研究类型/证据水平：经济/决策分析III级
