Chan T K Kevin, Portney David, Mamdouhi Tania, Janney Carol A, Chung Kevin C
Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
Department of Ophthalmology, University of Michigan, Ann Arbor, MI.
J Hand Surg Am. 2025 Jul;50(7):829-836. doi: 10.1016/j.jhsa.2025.04.004. Epub 2025 May 23.
Balancing surgical costs of care with reimbursements is important for the solvency of surgical practices and cost containment in the health care system. This study aimed to compare the day of surgery costs and incremental Medicare reimbursement for open reduction and internal fixation (ORIF) of intra-articular and extra-articular distal radius fractures (DRFs).
Using time data and supply costs at a single, large academic health center, we used a time-driven activity-based costing analysis to calculate the total day of surgery costs for ORIF of DRFs for the three current procedural terminology (CPT) codes 25607, 25608, and 25609, representing the spectrum of extra-articular to comminuted intra-articular fractures. We included patients with age >65 years with an isolated closed DRF. We compared the total costs of care during surgery with the incremental Medicare reimbursements for DRF ORIF.
We identified 193 DRFs, including 46 extra-articular DRFs (CPT 25607), 57 two-part intra-articular DRFs (CPT 25608), and 90 intra-articular DRFs ≥ 3 fragments (CPT 25609). Significant differences in the total day of surgery costs were observed between comminuted intra-articular DRF versus two-part intra-articular and extra-articular DRFs. Specifically, CPT 25609 cost $2147.63 more than CPT 25607 but was reimbursed an incremental average of $406.65 by Medicare, yielding a negative earnings difference of $1740.98. Additionally, CPT 25609 was more costly than CPT 25608 by a mean of $1620.54, yet was reimbursed an incremental average of $286.83. The net negative earnings difference was $1333.71. The largest contributions to the total day of surgery costs were the operating room and materials for all DRF surgeries.
The current time-driven activity-based costing analysis indicates that complex, comminuted intra-articular DRF ORIF is undervalued by Medicare.
The results may justify higher reimbursements for complex DRFs, although practicing surgeons should continue to lower the costs of care by efficiently performing ORIF and judiciously using implants.
平衡手术护理成本与报销费用对于手术科室的偿付能力以及医疗保健系统中的成本控制至关重要。本研究旨在比较关节内和关节外桡骨远端骨折（DRF）切开复位内固定术（ORIF）的手术日成本及医疗保险的增量报销情况。
利用一家大型学术医疗中心的时间数据和供应成本，我们采用了基于时间驱动的作业成本法分析，以计算当前三个程序编码（CPT）25607、25608和25609下DRF的ORIF手术日总成本，这三个编码代表了从关节外到粉碎性关节内骨折的范围。我们纳入了年龄大于65岁且患有孤立闭合性DRF的患者。我们比较了手术期间的护理总成本与DRF的ORIF的医疗保险增量报销情况。
我们识别出193例DRF，包括46例关节外DRF（CPT 25607）、57例两部分关节内DRF（CPT 25608）和90例关节内DRF≥3块碎片（CPT 25609）。在粉碎性关节内DRF与两部分关节内和关节外DRF之间，观察到手术日总成本存在显著差异。具体而言，CPT 25609比CPT 25607成本高2147.63美元，但医疗保险平均增量报销406.65美元，收益差异为负1740.98美元。此外，CPT 25609比CPT 25608平均成本高1620.54美元，但医疗保险平均增量报销286.83美元。净负收益差异为1333.71美元。所有DRF手术中，手术室和材料对手术日总成本的贡献最大。
当前基于时间驱动的作业成本法分析表明，医疗保险对复杂的粉碎性关节内DRF的ORIF估值偏低。
尽管执业外科医生应继续通过高效进行ORIF和明智使用植入物来降低护理成本，但这些结果可能证明对复杂DRF给予更高报销是合理的。
