Charges for Distal Radius Fracture Fixation Are Affected by Fracture Pattern,Location of Service,and Anesthesia Type

Abstract

Background:

This study sought to characterize charges associated with operative treatment of distal radius fractures and identify sources of variation contributing to overall cost.

Methods:

A retrospective study was performed using the New York Statewide Planning and Research Cooperative System database from 2009-2017. Outpatient claims were identified using the International Classification of Diseases-9/10-Clinical Modification diagnosis codes for distal radius fixation surgery. A multivariable mixed model regression was performed to identify variables contributing to total charges of the claim, including patient demographics, anesthesia method, surgery location (ambulatory surgery center [ASC] versus a hospital outpatient department [HOPD], operation time, insurance type, Charlson Comorbidity Index, and billed procedure codes.

Results:

A total of 9029 claims were included, finding older age, private primary insurance, surgery performed in a HOPD, and use of local anesthesia (vs general or regional) associated with increased total charges. There was no difference between gender, race, or ethnicity. Additionally, open reduction and internal fixation (ORIF), increased operative time/fracture complexity, and use of perioperative medications contributed significantly to overall costs.

Conclusions:

Charges for distal radius fracture surgery performed in a HOPD were 28.3% higher than compared to an ASC, and cases with local anesthesia had higher billed claims compared to regional or general anesthesia. Furthermore, charges for percutaneous fixation were 54.6% lower than ORIF of extraarticular fracture, and claims had substantial geographic variation. These findings may be used by providers and payers to help improve value of distal radius fracture care.

Level of Evidence:

Level III

Keywords

cost factors fixation fracture radius

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References

Khullar

Rajkumar

Innovations to cut US healthcare prices. BMJ. 2018;361:k1591. doi:10.1136/bmj.k1591.

Dieleman

Squires

Bui

, et al. Factors associated with increases in US health care spending, 1996-2013. J Am Med Assoc. 2017;318(17):1668-1678. doi:10.1001/jama.2017.15927.

Papanicolas

Woskie

Jha

AK.

Health care spending in the United States and other high-income countries. J Am Med Assoc. 2018;319(10):1024-1039. doi:10.1001/jama.2018.1150.

Wasterlain

Melamed

Bello

, et al. The effect of price on surgeons’ choice of implants: a randomized controlled survey. J Hand Surg Am. 2017;42(8):593-601.e6. doi:10.1016/j.jhsa.2017.05.005.

Mather

III Wysocki

Mack Aldridge

III , et al. Effect of facility on the operative costs of distal radius fractures. J Hand Surg Am. 2011;36(7):1142-1148. doi:10.1016/j.jhsa.2011.03.042.

Goodman

Modest

Johnson

, et al. Implant charge differences between distal radius fixation constructs (CPT 25607, 25608, and 25609). HAND. 2020. doi:10.1177/1558944720963927.

Okelana

McMillan

Kibble

, et al. Variation in implant selection for ankle fractures. J Orthop Trauma. 2019;33:S26-S31. doi:10.1097/BOT.0000000000001623.

Virkus

Wetzel

McKinley

, et al. Costs and radiographic outcomes of rotational ankle fractures treated by orthopaedic surgeons with or without trauma fellowship training. J Am Acad Orthop Surg. 2018;26(12):e261-e268. doi:10.5435/JAAOS-D-16-00687.

Huetteman

Zhong

Chung

KC.

Cost of surgical treatment for distal. J Hand Surg Am. 2018;43(8):720-730. doi:10.1016/j.jhsa.2018.05.007.

10.

Bhat

Liss

Beredjiklian

PK.

Economic analysis of the cost of implants used for treatment of distal radius fractures. Arch Bone Jt Surg. 2018;6(5):371-375. doi:10.22038/abjs.2017.23467.1619.

11.

Childs

Mann

Dahl

, et al. Differences in the treatment of distal radius fractures by hand fellowship trained surgeons: a study of ABOS candidate data. J Hand Surg Am. 2017;42(2):e91-e97. doi:10.1016/j.jhsa.2016.11.015.

12.

Navarro

Brolund

Ekholm

, et al. Treatment of radius or ulna fractures in the elderly: a systematic review covering effectiveness, safety, economic aspects and current practice. PLoS ONE. 2019;14(3):e0214362. doi:10.1371/journal.pone.0214362.

13.

Toon

Premchand

RAX

Sim

, et al. Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management. J Orthop Traumatol. 2017;18(3):229-234. doi:10.1007/s10195-016-0441-8.

14.

Pang

Truntzer

Baker

, et al. Cost minimization analysis of the treatment of distal radial fractures in the elderly. Bone Joint J. 2018;100(2):205-211. doi:10.1302/0301-620X.100B2.BJJ-2017-0358.R1.

15.

Costa

Achten

Plant

, et al. UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius. Health Technol Assess (Rockv). 2015;19(17):1-124. doi:10.3310/hta19170.

16.

Kazmers

Judson

Presson

, et al. Evaluation of factors driving cost variation for distal. J Hand Surg Am. 2018;43:606-614.e1. doi:10.1016/j.jhsa.2018.04.015.

17.

Basu

Manning

WB.

Issues for the next generation of health care cost analyses. Med Care. 2009;47:S109-S114. doi:10.1097/MLR.0b013e31819c94a1.

18.

Arora

Moriates

Shah

The challenge of understanding health care costs and charges. AMA J Ethics. 2015;17(11):1046-1052. doi:10.1001/journalofethics.2015.17.11.stas1-1511.

19.

US Bureau of Labor Statistics. CPI inflation calculator. Date unknown. https://www.bls.gov/data/inflation_calculator.htm. Accessed October 25, 2020.

20.

Deyo

Cherkin

Ciol

MA.

Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-619. doi:10.1016/0895-4356(92)90133-8.

21.

Physician Fee Schedule Search. Date unknown. https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed October 24, 2020.

22.

Tubeuf

Achten

, et al. Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: analysis from the drafft trial. Bone Joint J. 2015;97-B(8):1082-1089. doi:10.1302/0301-620X.97B8.35234.

23.

Nandyala

Giladi

Parker

, et al. Comparison of direct perioperative costs in treatment of unstable distal radial fractures. J Bone Jt Surg. 2018;100(9):786-792. doi:10.2106/JBJS.17.00688.

24.

Kakarlapudi

Santini

Shahane

, et al. The cost of treatment of distal radial fractures. Injury. 2000;31(4):229-232. doi:10.1016/S0020-1383(99)00248-X.

25.

Kazmers

Presson

, et al. Cost implications of varying the surgical technique, surgical setting, and anesthesia type for carpal tunnel release surgery. J Hand Surg Am. 2018;43(11):971-977. doi:10.1016/j.jhsa.2018.03.051.

26.

Crawford

Sprague

, et al. Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: a systematic review of the published literature. Orthop Rev (Pavia). 2015;7(4):6177. doi:10.4081/or.2015.6177.

27.

Johnson

Greenberg

Sathiyakumar

, et al. Relationship between the Charlson Comorbidity Index and cost of treating hip fractures: implications for bundled payment. J Orthop Traumatol. 2015;16:209-213. doi:10.1007/s10195-015-0337-z.

28.

Lalonde

Martin

Tumescent local anesthesia for hand surgery: improved results, cost effectiveness, and wide-awake patient satisfaction. Arch Plast Surg. 2014;41(4):312-316. doi:10.5999/aps.2014.41.4.312.

29.

Tang

Xing

Ayhan

, et al. Impact of wide-awake local anesthesia no tourniquet on departmental settings, cost, patient and surgeon satisfaction, and beyond. Hand Clin. 2019;35(1):29-34. doi:10.1016/j.hcl.2018.08.012.

30.

Goz

Rane

Abtahi

, et al. Geographic variations in the cost of spine surgery. Spine (Phila Pa 1976). 2015;40(17):1380-1389. doi:10.1097/BRS.0000000000001022.

31.

Thakore

Greenberg

Bulka

, et al. Geographic variations in hospital charges and Medicare payments for major joint arthroplasty. J Arthroplasty. 2015;30(5):728-732. doi:10.1016/j.arth.2014.12.011.

32.

Fisher

Wennberg

Stukel

, et al. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4):273-287. doi:10.7326/0003-4819-138-4-200302180-00006.

33.

Veltre

Yakavonis

Curry

, et al. Regional variations of Medicare physician payments for hand surgery procedures in the United States. Hand (N Y). 2019;14(2):209-216. doi:10.1177/1558944717734370.

34.

Sun

Baker

LC.

Concentration in orthopedic markets was associated with a 7 percent increase in physician fees for total knee replacements. Health Aff (Millwood). 2015;34(6):916-921. doi:10.1377/hlthaff.2014.1325.

35.

Zhang

Cowling

Facer

Comparing the effects of reference pricing and centers-of-excellence approaches to value-based benefit design. Health Aff. 2017;36(12):2094-2101. doi:10.1377/hlthaff.2017.0563.

36.

Morche

Mathes

Pieper

Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev. 2016;5(1):204. doi:10.1186/s13643-016-0376-4.

37.

Day

Alexander

Lal

, et al. Effects of workers’ compensation on the diagnosis and surgical treatment of patients with hand and wrist disorders. J Bone Joint Surg Am. 2010;92(13):2294-2299. doi:10.2106/JBJS.I.00158.

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