Reimbursement for Complex Carpal Trauma

Objectives: To compare Relative Value Unit (RVU)-based reimbursement of operative fixation of complex carpal trauma versus primary operative fixation of distal radius fractures. Design: Database review. Setting: National Surgical Quality Improvement Program (ACS-NSQIP) database Intervention: Surgical treatment of complex carpal trauma and distal radius fracture. Main outcome measurement: Mean and median total work Relative Value Unit (wRVU), surgical time, wRVU/minute, reimbursement/minute, reimbursement/surgical case. Results: 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.   Conclusions: 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. Level of Evidence: IV; Economic Analysis Keywords: Complex carpal trauma, relative value unit, wRVU, reimbursement, distal radius fracture (J Ortho Business 2022; Volume 1, Issue 1:pages 19-23)