Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Georgetown University School of Medicine, Washington, DC, USA.
J Shoulder Elbow Surg. 2022 Sep;31(9):1884-1889. doi: 10.1016/j.jse.2022.02.038. Epub 2022 Apr 13.
Movement toward providing value-based musculoskeletal care requires understanding the cost associated with surgical care as well as the drivers of these costs. The aim of this study was to investigate the effect of common medical comorbidities and specific total elbow arthroplasty (TEA) indications on reimbursement costs throughout the 90-day TEA episode of care. The secondary aim was to identify the drivers of these costs.
Administrative health claims for patients who underwent orthopedic intervention between 2010 and 2020 were queried using specific disease classification and procedural terminology codes from a commercially available national database of 53 million patients. Patients with commercial insurance were divided into various cohorts determined by different surgical indications and medical comorbidities. The reimbursement costs of the surgical encounter, 89-day postoperative period, and total 90-day period in each cohort were evaluated. The cost drivers for the 89-day postoperative period were also determined. Analyses were performed using descriptive statistics and the Kruskal-Wallis test for comparison.
A total of 378 patients who underwent TEA were identified. The mean reimbursement cost of the surgical encounter ($13,393 ± $8314) did not differ significantly based on patient factors. The mean reimbursement cost of the 89-day postoperative period ($4232 ± $2343) differed significantly when stratified by surgical indication (P < .0001) or by medical comorbidity (P < .0001). The indication of rheumatoid arthritis ($4864 ± $1136) and the comorbidity of chronic kidney disease ($5873 ± $1165) had the most expensive postoperative period. In addition, the total 90-day reimbursement cost ($16,982 ± $4132) differed significantly when stratified by surgical indication (P = .00083) or by medical comorbidity (P < .0001), with the indication of acute fracture ($18,870 ± $3971) and the comorbidity of chronic pulmonary disease ($19,194 ± $3829) showing the highest total 90-day cost. Inpatient costs related to readmissions represented 38% of the total reimbursement cost. The overall readmission rate was 5.0%, and the mean readmission cost was $16,296.
TEA reimbursements are significantly influenced by surgical indications and medical comorbidities during the postoperative period and the total 90-day episode of care. As the United States transitions to delivering value-based health care, the need for surgeons and policy makers to understand treatment costs associated with different patient-level factors will expand.
向基于价值的肌肉骨骼护理转变需要了解手术护理相关的成本以及这些成本的驱动因素。本研究旨在调查常见的医疗合并症和特定的全肘人工关节置换术（TEA）适应证对整个 90 天 TEA 治疗期间报销费用的影响。次要目的是确定这些成本的驱动因素。
使用来自 5300 万患者的商业可用国家数据库中的特定疾病分类和程序术语代码，查询 2010 年至 2020 年接受骨科干预的患者的行政健康索赔数据。有商业保险的患者根据不同的手术适应证和医疗合并症分为不同的队列。评估每个队列中手术就诊、术后 89 天和整个 90 天期间的报销费用。还确定了术后 89 天的成本驱动因素。使用描述性统计和 Kruskal-Wallis 检验进行分析比较。
共确定了 378 名接受 TEA 的患者。手术就诊的平均报销费用（$13393±$8314）不因患者因素而有显著差异。术后 89 天的平均报销费用（$4232±$2343）根据手术适应证（P<.0001）或医疗合并症（P<.0001）分层有显著差异。类风湿关节炎（$4864±$1136）和慢性肾脏病（$5873±$1165）的合并症具有最昂贵的术后期间。此外，根据手术适应证（P=0.00083）或医疗合并症（P<.0001）分层，整个 90 天的报销费用（$16982±$4132）有显著差异，急性骨折（$18870±$3971）和慢性肺病（$19194±$3829）的适应证显示出最高的总 90 天费用。与再入院相关的住院费用占总报销费用的 38%。总的再入院率为 5.0%，平均再入院费用为$16296。
TEA 的报销费用在术后期间和整个 90 天的治疗期间受到手术适应证和医疗合并症的显著影响。随着美国向提供基于价值的医疗保健转变，外科医生和政策制定者需要了解与不同患者水平因素相关的治疗成本的需求将会扩大。
