Level II trauma centers have highest charges for hip fractures
DOI:
https://doi.org/10.55576/job.v2i1.5Keywords:
hip fracture, cost analysis, TexasAbstract
Objectives: To evaluate the charges for pertrochanteric hip fracture care in Texas.
Design: Database review.
Setting: Texas Hospital Inpatient Public Use Data File (PUDF)
Intervention: Charges reported by hospitals to the Texas Department of State Health Services for pertrochanteric hip fractures.
Main outcome measurement: Charges associated with pertrochanteric hip fracture stratified by implant type and according to facility trauma level designation, urban versus rural, teaching versus non-teaching, and border versus inland status.
Results and conclusions: There were a total of 44,853 pertrochanteric hip fracture surgeries performed over the three-year period in the state of Texas. The vast majority were treated at urban (93.4%), inland (non-border) (92.3%), non-teaching (74.2%) facilities with intramedullary fixation (56.9%). A significant increase in charges was associated with treatment at an urban ($32,412), border ($44,919), or teaching ($10,501) facility. Mean inpatient charges at Level II facilities was $113,700. Further study is warranted to determine what drives the differences in charges associated with hip fracture treatment.
Level of Evidence: IV; Economic Database Analysis
Keywords: hip fracture, access to care, charge analysis, value-based care, Texas.
(J Ortho Business 2022; 1:4-6)
References
Adeyemi A, Delhougne G. Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis. JBJS Open Access. 2019;4(1):e0045.
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. Oct 14 2009;302(14):1573-9. doi:10.1001/jama.2009.1462
Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. Aug 2018;49(8):1458-1460. doi:10.1016/j.injury.2018.04.015
Coyle S, Kinsella S, Lenehan B, Queally JM. Cost-utility analysis in orthopaedic trauma; what pays? A systematic review. Injury. Mar 2018;49(3):575-584. doi:10.1016/j.injury.2018.01.029
Samuel AM, Webb ML, Lukasiewicz AM, et al. Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement. Clin Orthop Relat Res. Jun 2016;474(6):1486-94. doi:10.1007/s11999-016-4765-8
Lott A, Belayneh R, Haglin J, Konda S, Egol KA. Effectiveness of a Model Bundle Payment Initiative for Femur Fracture Patients. J Orthop Trauma. Sep 2018;32(9):439-444. doi:10.1097/BOT.0000000000001229
Konda SR, Lott A, Egol KA. The Coming Hip and Femur Fracture Bundle: A New Inpatient Risk Stratification Tool for Care Providers. Geriatr Orthop Surg Rehabil. 2018;9:2151459318795311. doi:10.1177/2151459318795311
White C, Whaley CM. Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely: Findings from an Employer-Led Transparency Initiative. Rand Health Q. 2021;9(2):5. Published 2021 Aug 16.
Silber JH, Rosenbaum PR, Niknam BA, et al. Comparing Outcomes and Costs of Surgical Patients Treated at Major Teaching and Nonteaching Hospitals: A National Matched Analysis. Ann Surg. 2020;271(3):412-421. doi:10.1097/SLA.0000000000003602
Lavernia CJ, Sierra RJ, Hernandez RA. The cost of teaching total knee arthroplasty surgery to orthopaedic surgery residents. Clin Orthop Relat Res. 2000;(380):99-107. doi:10.1097/00003086-200011000-00014
Konda SR, Lott A, Manoli A 3rd, Patel K, Egol KA. Hip Fracture Treatment at Orthopaedic Teaching Hospitals: Better Care at a Lower Cost. J Orthop Trauma. 2017;31(11):e364-e368. doi:10.1097/BOT.0000000000000927
Services TDoSH. Texas Trauma Facilities. 2020. https://dshs.texas.gov/emstraumasystems/etrahosp.shtm
Crichlow RJ, Zeni A, Reveal G, et al. Appropriateness of patient transfer with associated orthopaedic injuries to a Level I trauma center. J Orthop Trauma. Jun 2010;24(6):331-5. doi:10.1097/BOT.0b013e3181ddfde9
Mamczak CN, Streubel PN, Gardner MJ, Ricci WM. Unravelling the debate over orthopaedic trauma transfers: The sender's perspective. Injury. Dec 2013;44(12):1832-7. doi:10.1016/j.injury.2013.03.035
Clancy TV, Gary Maxwell J, Covington DL, Brinker CC, Blackman D. A statewide analysis of level I and II trauma centers for patients with major injuries. J Trauma. Aug 2001;51(2):346-51. doi:10.1097/00005373-200108000-00021
Ciesla DJ, Pracht EE, Leitz PT, Spain DA, Staudenmayer KL, Tepas JJ, 3rd. The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system. J Trauma Acute Care Surg. Jun 2017;82(6):1014-1022. doi:10.1097/TA.0000000000001442
Tepas JJ, 3rd, Kerwin AJ, Ra JH. Unregulated proliferation of trauma centers undermines cost efficiency of population-based injury control. J Trauma Acute Care Surg. Mar 2014;76(3):576-9; discussion 579-81. doi:10.1097/TA.0000000000000125
Mabry CD, Kalkwarf KJ, Betzold RD, et al. Determining the hospital trauma financial impact in a statewide trauma system. J Am Coll Surg. Apr 2015;220(4):446-58. doi:10.1016/j.jamcollsurg.2014.12.039
Rutledge R, Shaffer VD, Ridky J. Trauma care reimbursement in rural hospitals: implications for triage and trauma system design. J Trauma. Jun 1996;40(6):1002-8. doi:10.1097/00005373-199606000-00025
Galanis DJ, Steinemann S, Rosen L, Bronstein AC, Biffl WL. Rural Level III centers in an inclusive trauma system reduce the need for interfacility transfer. J Trauma Acute Care Surg. Oct 2018;85(4):747-751. doi:10.1097/TA.0000000000002033
Castelli A, Daidone S, Jacobs R, Kasteridis P, Street AD. The Determinants of Costs and Length of Stay for Hip Fracture Patients. PLoS One. 2015;10(7):e0133545. doi:10.1371/journal.pone.0133545
Kelly B, Parikh HR, McCreary DL, McMillan L, Horst PK, Cunningham BP. Financial Implications for the Treatment of Medicare Patients With Isolated Intertrochanteric Femur Fractures: Disproportionate Losses Among Healthier Patients. Geriatr Orthop Surg Rehabil. 2020;11:2151459320916947.
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