Journal of Orthopaedic Business最新文献

{"title":"Reimbursement for Complex Carpal Trauma","authors":"J. Dunn, John P. Scanaliato, Clare K. Green, P. Rhee, L. Nesti","doi":"10.55576/job.v2i1.12","DOIUrl":"https://doi.org/10.55576/job.v2i1.12","url":null,"abstract":"Objectives: To compare Relative Value Unit (RVU)-based reimbursement of operative fixation of complex carpal trauma versus primary operative fixation of distal radius fractures.\u0000Design: Database review.\u0000Setting: National Surgical Quality Improvement Program (ACS-NSQIP) database\u0000Intervention: Surgical treatment of complex carpal trauma and distal radius fracture.\u0000Main outcome measurement: Mean and median total work Relative Value Unit (wRVU), surgical time, wRVU/minute, reimbursement/minute, reimbursement/surgical case.\u0000Results: The 139 patients who underwent fixation of complex carpal trauma and 222 patients who underwent fixation of distal radius fractures were included in this study. The mean wRVUs were 10.56 for the complex carpal trauma group and 12.46 for the distal radius fracture group. Complex carpal trauma cases were an average of 31 minutes longer than distal radius fracture cases. Mean wRVU/minute (0.19 vs 0.14) and median wRVU/minute (0.18 vs 0.11) were higher for distal radius fracture cases than for complex carpal trauma cases (percent difference: mean 34%, median 62%). Lastly, the mean ($378.85) and median reimbursement ($383.29) per surgical case for complex carpal trauma was lower than that of the mean ($447.19) and median reimbursement ($516.08) of distal radius fractures.\u0000 \u0000Conclusions: Despite longer operative times and increased procedural complexity, surgical treatment of complex carpal trauma is reimbursed significantly less than surgical treatment of distal radius fractures. The authors advocate a threefold plan. First, the ACS may consider developing more clear guidelines on the definition of a hand surgeon. Second, hand surgeons must insert themselves into hospital policy making, particularly with call and consult management discussions. Finally, considering the three components of the RVU calculation (physician work, physician expertise, and liability), the management of complex carpal trauma is under-recognized and reimbursed. As such, the authors recommend consideration of these injuries to be recompensed commiserate with arthroplasty and orthopaedic trauma.\u0000Level of Evidence: IV; Economic Analysis\u0000Keywords: Complex carpal trauma, relative value unit, wRVU, reimbursement, distal radius fracture\u0000(J Ortho Business 2022; Volume 1, Issue 1:pages 19-23)","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116955788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Analysis of an In-House Arthroscopic Skills Simulator","authors":"Joshua Hansen, Corbin Lee, Bryson Hewins, Austin MacDonald, Austin Rasmussen, E. Weissbrod, J. Lopreiato, B. Franklin","doi":"10.55576/job.v2i1.8","DOIUrl":"https://doi.org/10.55576/job.v2i1.8","url":null,"abstract":"Objectives: To compare objective costs between an in-house developed arthroscopy simulator and commercially available options.\u0000Design: Cost analysis.\u0000Setting: Orthopaedic graduate medical education.\u0000Patients/Participants: Eight board-certified orthopaedic surgeons and nineteen novice learners.\u0000Intervention: Simulation Training.\u0000Main outcome measurement: Cost difference between an in-house developed simulator and a commercially available simulator.\u0000Results and conclusions: Significant price differences exist between in-house simulator production cost and commercially available simulators. Low-cost, in-house simulators improve access to arthroscopic simulation training for novice learners by reducing up front cost by 29% and reducing recurring costs by over 90% when compared to a similar commercially available option.\u0000Level of Evidence: IV; Cost Analysis\u0000Keywords: Education; Simulation; Orthopaedics; Arthroscopy; Simulation Based Learning Theory\u0000(J Ortho Business Jan 2022;2(1):7-9)\u0000 \u0000 ","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131622583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid Reimbursement of Pediatric Surgeries","authors":"M. Eckhoff, Joshua C. Tadlock","doi":"10.55576/job.v2i1.10","DOIUrl":"https://doi.org/10.55576/job.v2i1.10","url":null,"abstract":"Intro: Medicaid is an important means of health care insurance for millions of people in the United States and 49.5% of Medicaid patients are children. . Reimbursements in Medicaid have been shown to be a limiting factor in access to health care in pediatric patients. This study investigates the amount of difference in reimbursement between Medicaid and Medicare, as well as state to state variability. \u0000Methods: Medicaid and Medicare fee reimbursements were collected from each state for 10 different common pediatric orthopedic procedures. The difference between and variability of reimbursement were calculated for both Medicaid and Medicare. \u0000Results: There was an average difference of -22.2% ± 26.9 or -$184.14 ± $226.89 in Medicaid reimbursement compared to Medicare. New Jersey had the greatest difference at 72.7% less reimbursement with Medicaid, while Delaware had higher Medicaid reimbursement of 95.2% compared to Medicare. Only three states had higher reimbursement with Medicaid compared to Medicare for all 10 procedures. Additionally, there was statistically higher coefficient of variation with Medicaid reimbursement compared to Medicare (0.26 vs 0.46) among states. \u0000Conclusion: Medicaid reimbursement is significantly lower compared to Medicare for several common pediatric orthopedic procedures across the United States. The lower Medicaid reimbursement fees may contribute as a barrier to care access for an at-risk population of children.","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114361215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Level II trauma centers have highest charges for hip fractures","authors":"Joshua E Simson, E. Vázquez, J. Dunn, James H Nelson","doi":"10.55576/job.v2i1.5","DOIUrl":"https://doi.org/10.55576/job.v2i1.5","url":null,"abstract":"Objectives: To evaluate the charges for pertrochanteric hip fracture care in Texas.\u0000Design: Database review.\u0000Setting: Texas Hospital Inpatient Public Use Data File (PUDF)\u0000Intervention: Charges reported by hospitals to the Texas Department of State Health Services for pertrochanteric hip fractures.\u0000Main 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.\u0000Results 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.\u0000Level of Evidence: IV; Economic Database Analysis\u0000Keywords: hip fracture, access to care, charge analysis, value-based care, Texas.\u0000 (J Ortho Business 2022; 1:4-6)","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128720788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopaedic Business is the Focus of 3.4% of Articles in Top General Orthopaedic Journals.","authors":"Nicholas Thomas, A. Sandler, Isaac Fernandez, Joshua E Simson, Mikel Tihista, Matthew E. Wells, Benjamin R. Childs","doi":"10.55576/job.v2i1.11","DOIUrl":"https://doi.org/10.55576/job.v2i1.11","url":null,"abstract":"Objectives: The purpose of this study is to compare the proportion of business articles in top general orthopaedic journals.\u0000Design: Review.\u0000Intervention: Categorize all articles from general orthopaedic journals with top four H-Index.\u0000Main outcome measurement: Articles categorized as payer analysis (PA), cost analysis (CA), value-based practice (VBP), Management and human resources (HR), practice efficiency (PE) and the business of scholarship (SC).\u0000Results and conclusions: JBJS, B&JJ, CORR, and JAAOS were identified as top orthopaedic journals. All had some level of business scholarship with an average of 3.4% of articles dedicated to business, ranging from 2 to 7%.  Of business-related articles 27% of articles were cost analysis, 25% focused on practice efficiency, 22% on Value based practices, 16% payer analysis, 7% business of scholarship and 4% on human resources. The lack of scholarship regarding human resources represents a significant opportunity for improvement as a profession.\u0000Level of Evidence: IV; Review\u0000Keywords: Business, management, human resources, cost, value, efficiency.\u0000(J Ortho Business 2021; 2:9-12)","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132889312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free-vascularized bone grafts for scaphoid non-unions viable as outpatient procedure?","authors":"Matthew E. Wells, Kyle Klahs, Michael M. Polmear, L. Nesti, J. Dunn","doi":"10.55576/job.v1i2.6","DOIUrl":"https://doi.org/10.55576/job.v1i2.6","url":null,"abstract":"Objective: To determine if free vascularized bone grafting procedures are considered safe to perform for outpatient treatment in the setting of scaphoid non-union.\u0000Setting: Utilizing The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) scaphoid nonunion cases were isolated and investigated.\u0000Patients/Participants: A total of 50 patients with scaphoid fractures treated with vascularized bone graft were identified. \u0000Intervention: Bone graft with microvascular anastomosis for closed fracture of the scaphoid\u0000Main Outcome Measurements: Length of hospital stay, acute (30 day) complication rates\u0000Results: The average length of hospital stay was 1.2 days and 18 patients (36%) were discharged the same day of surgery. There were no complications reported within the 30-day post-operative period.\u0000Conclusion: The reported early morbidity and mortality rates of free vascularized bone grafting in the setting of scaphoid fractures have been reported to be minimal. These rare early complications include superficial surgical site infections and pin site irritation. In this analysis, there were no reported adverse outcomes. Given the low risks for acute complications, vascularized bone transfer surgery in the setting of scaphoid nonunion can be considered safe and potentially cost effective to perform on an outpatient basis.\u0000Level of Evidence: IV\u0000Keywords: Scaphoid fracture; scaphoid nonunion; free vascularized bone graft; ambulatory surgery; outpatient surgery; cost effectiveness\u0000(J Ortho Business 2021 Oct 1;1(2):5-8)","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123877116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could H Index be a Beneficial Prospective Promotion Metric?","authors":"Clare K. Green, Michael M. Polmear, N. Parnes, J. Dunn, John P. Scanaliato","doi":"10.55576/job.v1i2.7","DOIUrl":"https://doi.org/10.55576/job.v1i2.7","url":null,"abstract":"Objectives \u0000The purpose of this study is to investigate the association between Hirsch index and academic rank among shoulder and elbow surgeons affiliated with American Shoulder and Elbow Surgery (ASES) fellowship programs. Additional variables investigated included total number of publications and training program affiliation. \u0000  \u0000Design \u0000Database review \u0000  \u0000Intervention \u0000H-index, total number of publications, academic rank, and fellowship training pedigree for shoulder and elbow surgeons on faculty at ASES fellowship programs. \u0000  \u0000Main Outcome Measurement \u0000Data normality was assessed using the Shapiro-Wilk test. Variance was assessed using Kruskall-Wallis test for non-parametric data that were not normally distributed due to skew and outliers. Post-hoc analysis on non-normally distributed data was performed using Mann-Whitney test with Bonferroni correction. Median differences for non-normal data were determined by Hodges-Lehman estimation. \u0000  \u0000Results \u0000There is a strong correlation between total number of publications and h-index. Overall, there is a strong association with number of publications, h-index and training program affiliation with higher academic rank, except at the chair/director position. Type of fellowship training was not a significant predictor of academic rank. A higher proportion of junior faculty were found to have faculty appointments with their home training program. \u0000  \u0000Conclusion \u0000H-index and total number of publications are associated with a higher academic rank for full-time shoulder and elbow fellowship affiliated surgeons.","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116475150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial Impact of the Surgical Treatment of Infection on the Practice of Orthopedic Trauma","authors":"Daniel C Flinn, Taylor P. Gurnea, P. Althausen","doi":"10.55576/job.v1i1.4","DOIUrl":"https://doi.org/10.55576/job.v1i1.4","url":null,"abstract":"Objectives: The treatment of bone, muscle, and joint infections has been under the purview of orthopedic surgeons for years. As care has become more specialized, orthopedic surgeons are offloading infection cases to services such as general surgery or podiatry. Orthopedics as a field has already yielded portions of spine to neurosurgery, recovery to physiatrists, and foot and ankle to podiatry. The purpose of this study was to report the financial impact of infection treatment on our group practice at a busy community Level II trauma center. \u0000Design: Retrospective Economic Review \u0000Setting: Level II Trauma Center \u0000Patients/Participants: All patients receiving orthopedic surgical intervention at our facility from January 1, 2018 to December 31, 2018. \u0000Intervention: Surgical treatment of bone, muscle and joint infections. \u0000Main Outcome Measurements: Surgical Volume, Relative Value Units, Physician Charges, Physician Collections and Payer Mix \u0000Results: The surgical treatment of infections including irrigation and debridement, wound closure and amputations amounted to 908 out of 3700 total cases. This included 11,405 total RVUs, 5,771 work RVUs, $2,056,677 in charges and $407,479 in collections over the 2018 calendar year. This was 16.8% of total RVUs, 19% of all charges, and 15% of collections for the orthopedic trauma service. The payer mix for these patients was less favorable with a collection rate of 20% compared to a 25% average for all surgical cases. \u0000Conclusions: The treatment of orthopedic infections represents a large proportion of surgical volume for orthopedic surgeons covering hospital call. Relinquishing control of these patients will result in significant financial loss as well as a decrease in our ability to control the episode of care and patient access in the changing healthcare environment. \u0000Level of Evidence: Therapeutic Level III","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127561329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care of low-income patients with sports injuries disincentivized by government reimbursement","authors":"Clare K. Green, Michael M. Polmear, J. Dunn, N. Parnes, John P. Scanaliato","doi":"10.55576/job.v1i1.3","DOIUrl":"https://doi.org/10.55576/job.v1i1.3","url":null,"abstract":"Objectives: The purpose of this study is to compare Medicaid reimbursement rates with regional Medicare reimbursement for 10 commonly performed orthopaedic sports medicine procedures.\u0000Design: Database review.\u0000Setting: State Medicaid physician fee schedules and national Medicare fee schedule.\u0000Intervention: Medicaid and Medicare reimbursement for meniscus debridement (medial or lateral), meniscus repair (medial or lateral), anterior cruciate ligament (ACL) reconstruction, posterior cruciate ligament (PCL) reconstruction, anterior labral (Bankart) repair, rotator cuff repair, biceps tenodesis, femoral osteochondroplasty, acetabular osteoplasty, and acetabular labral repair.\u0000Main outcome measurement: Overall Medicaid to Medicare reimbursement ratio, dollar difference between Medicaid and Medicare reimbursement, dollar difference between Medicaid and Medicare per relative value unit (RVU), dispersion of reimbursement rates.\u0000Results and conclusions: Significant discrepancies were found between Medicaid and Medicare reimbursement for all 10 procedures, with Medicaid reimbursing on average 65.15% of the Medicare rate. Medicaid reimbursement also exhibited substantial variation between individual state programs. Financial incentives matter and between these two government programs, orthopaedic surgeons are incentivized to provide care to elderly patients over poorer patients.\u0000Level of Evidence: IV; Economic Analysis\u0000Keywords: Medicaid; Medicare; Reimbursement; RVU; Variation\u0000(J Ortho Business 2021; 1:4-6)","PeriodicalId":152360,"journal":{"name":"Journal of Orthopaedic Business","volume":"497 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126559406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}