Study finds an increasing gap between hospital and surgeon payments for THA
Surgeon charges and payments are not increasing at the same rate as hospital charges and payments for total hip arthroplasty, even with stable patient comorbidity rates and a decreasing length of stay, according to study results.
Brian C. Werner, MD, FAAOS, and colleagues at the University of Virginia’s department of orthopedic surgery examined variation between hospital and surgeon payments and charges for THA in a 5% Medicare sample (56,228 patients) from 2005 to 2014.
According to the study, the researchers used a charge multiplier (CM), which is the ratio of hospital to surgeon charges, and a patient multiplier (PM), which is the ratio of hospital to surgeon payments, to assess financial variation.
The researchers found hospital charges per patient increased from $38,988 to $60,928, with surgeon charges increasing from $4,480 to $5,321 (CM increase of 8.7 to 11.5). Furthermore, hospital payments per patient increased from $10,455 to $12,847, with surgeon payments decreasing from $946 to $843 (PM increase of 11 to 15.2).
The final phase of the study assessed trends that could contribute to this financial imbalance.
“While there has certainly been an increase in implant costs that may contribute, other factors that contribute to hospital costs, such as patient complexity, have remained stable and length of stay (LOS) has decreased,” Werner told Healio Orthopedics.
Throughout the study, LOS decreased from 4.1 to 3 days, while the Charlson Comorbidity Index remained stable.
“We hope that the findings of this and other studies encourage the key stakeholders to have more discussions about aligning the incentives of hospitals and surgeons and searching for better methods of cost containment,” Werner said. “The reader should also be aware there are a number of limitations of this type of cost analysis, and that future more detailed cost analyses are needed at the individual hospital levels to truly understand the complex relationship between surgeon and hospital charges and reimbursements for THA.” – by Max R. Wursta
Werner B, et al. ePaper 025. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Werner reports he is a board or committee member of the American Shoulder and Elbow Surgeons and the American Orthopaedic Society for Sports Medicine; is a paid presenter or speaker of Arthrex Inc.; and provides research support for Arthrex Inc., Zimmer Biomet and Integra LifeScience.