Evaluation of Factors Driving Cost Variation for Distal Radius Fracture Open Reduction Internal Fixation

Kazmers, Nikolas H.; Judson, Christopher H.; Presson, Angela P.; Xu, Yizhe; Tyser, Andrew R.

doi:10.1016/j.jhsa.2018.04.015

Cited by 34 publications

(32 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…VDO costing methods have been previously described, which allow access to total direct costs for materials used for patient care, facility utilization direct costs (including sterile processing costs), and timebased cost allocations including procedure/operative time and cost of staff involved in care (nursing, surgical technicians, and medical assistants). 1,13,14,16,20,23 As the outcome measure was total direct costs, rather than payments, reimbursement for the surgeon, anesthesiologist, and facility were not included; however, time-allocated costs for the surgeon, anesthesiologist, and facility use were captured by the database. All cost categories captured by the VDO tool are further illustrated in ►Appendix A.…”

Section: Operating Room Protocolmentioning

confidence: 99%

“…This has successfully identified areas of high variability in cost, leading to improved value of care delivered 1 and identification of sources of cost variation that may be targeted to improve value. [13][14][15][16][17][18] In the current study, the VDO tool was utilized to answer our primary study question of whether the choice of surgical setting (OR vs. PR), and anesthetic type (local only, BB, MAC, or GA) affect surgical encounter costs for DQR.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Stephens

Presson

et al. 2020

J Wrist Surg

Self Cite

View full text Add to dashboard Cite

Background First extensor compartment release is a common surgical procedure that represents a financial burden to the health care system. Questions/Purposes Study questions included (1) whether surgical encounter costs differ based upon surgical setting (operating room [OR] vs. procedure room [PR]) or (2) based upon anesthesia choice (local only, Bier's block [BB], monitored anesthesia care [MAC], or general [GA]) for De Quervain release (DQR). Patients and Methods Consecutive adult patients undergoing isolated unilateral DQR at a single academic medical center were identified retrospectively by Current Procedural Terminology code (25000). Using our institution's information technology value tools, we calculated total direct costs for each surgical encounter. Costs were adjusted to January 2016 dollars using the Consumer Price Index, normalized using each participant's surgical encounter cost divided by the median cost in the PR group, then compared across each group using Kruskal–Wallis and Nemenyi's post hoc pair-wise tests. Multivariable gamma regression analysis with a log link was performed to identify factors associated with surgical costs. QuickDASH (disabilities of the arm, shoulder, and the hand) scores were compared using a t-test at final follow-up. Results Among 58 included patients, 29% (17/58) were treated in the PR and 71% (41/58) in the OR. Compared with local only in the PR, all other groups were significantly more costly. Multivariable gamma regression indicated that use of OR/BB, OR/MAC, or OR/GA independently led to 211, 222, and 357% greater surgical costs as compared with the PR with local only while controlling for provider and patient age. Furthermore, QuickDASH scores were similar between PR and OR groups at final follow-up. Conclusion Performing DQR in the PR setting under local only anesthesia yields greater value than the OR, as patient-reported outcomes are similar despite significantly lower surgical costs. Level of Evidence This is a Level III, cost analysis study.

show abstract

Section: Operating Room Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Stephens

Presson

et al. 2020

J Wrist Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although we did not have enough variation in implant manufacturer at our institution to evaluate the contribution of this variable to cost variation, prior studies have shown that manufacturer significantly influences cost variation. 19 …”

Section: Discussionmentioning

confidence: 99%

“…Previous literature using this tool in orthopedics has demonstrated that pharmacy, laboratory, and imaging costs comprise a relatively small portion (<5%) of the SETDC and therefore contribute minimally to surgical cost variation. 19 , 20 , 22 Therefore, we chose to omit these categories rather than exclude all inpatient surgeries. Additionally, professional payments including those to the surgeon and anesthesiologist, and indirect costs such as facility or equipment depreciation, are not included.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of factors driving cost variation for distal humerus open reduction internal fixation

Zeidan¹,

Stephens²,

Zhang³

et al. 2021

JSES International

Self Cite

View full text Add to dashboard Cite

Background Distal humerus fracture open reduction and internal fixation (ORIF) represents a substantial cost burden to the health care system. The purpose of this study was to describe surgical encounter cost variation for distal humerus ORIF, and to determine demographic-, injury-, and treatment-specific factors that influence cost. Methods We retrospectively identified adult patients (≥18 years) treated for isolated distal humerus fractures between July 2014 and July 2019 at a single tertiary academic referral center. For each case, surgical encounter total direct costs (SETDCs) were obtained via our institution's information technology value tools, which prospectively record granular direct cost data for every health care encounter. Costs were converted to 2019 dollars using the personal consumption expenditure indices for health and summarized with descriptive statistics. Univariate and multivariate linear regression models were used to identify factors influencing SETDC. Results Surgical costs varied widely for the 47 included patients, with a standard deviation (SD) of 33% and interquartile range of 76%-124% relative to the mean SETDC. Implant and facility costs were responsible for 46.2% and 32.6% of the SETDC, respectively. Implant costs also varied considerably, with an SD of 21% and range from 13%-36% relative to the mean SETDC. Multivariate analysis demonstrated that SETDC increased 24% ( P < .001) on performing an olecranon osteotomy, and by 15% for each additional 1 hour of surgical time ( P < .001). These findings were independent of age, sex, body mass index, open fracture, need for an additional small plate construct as a reduction aid, and fracture pattern (all insignificant in the multivariate analysis, with P >.05 for each factor). Conclusion Substantial variations in surgical encounter total direct costs for distal humerus ORIF exist, as do wide variations in associated implant costs that comprise nearly half of the entire surgical cost. Performing an olecranon osteotomy, and increased surgical time, significantly increased surgical costs. Although use of an olecranon osteotomy may not be a completely controllable factor as it is confounded by fracture severity and operative time, this may suggest that surgeons should try to use an olecranon osteotomy judiciously. Although complexity of the fracture pattern was statistically insignificant, it is confounded by the need for an olecranon osteotomy and increased surgical time and likely is a clinically relevant and nonmodifiable driver of surgical cost. These findings highlight opportunities to reduce cost variation, and potentially improve the value of care, for distal humerus ORIF patients.

show abstract

“…30 Furthermore, due to differences in contracting between different hospitals, implant costs are known to vary widely across the nation. [31][32][33] If bundled payments for hip fractures are implemented on a national scale, controlling the cost variation of these implants will be one of the few ways to bring about value in care. Implementing value-based purchasing programs that ensure alignment of physician incentives with that of the hospital involves careful review of potential conflicts of interest between the implant companies and physicians, uses price transparency to compare implant costs across other institutions, and involves a technology review of the efficacy of new implants will be an effective way of implementing an aggressive contracting policy with industry companies to reduce costs.…”

Section: Challenges and Opportunities Of Including Hip Fractures In Bmentioning

confidence: 99%

The “Hip Fracture” Bundle—Experiences, Challenges, and Opportunities

Malik

Khan

et al. 2020

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction: With growing popularity and success of alternative-payment models (APMs) in elective total joint arthroplasties, there has been recent discussion on the probability of implementing APMs for geriatric hip fractures as well. Significance: Despite the growing interest, little is known about the drawbacks and challenges that will be faced in a stipulated “hip fracture” bundle. Results: Given the varying intricacies and complexities of hip fractures, a “one-size-fits-all” bundled payment may not be an amenable way of ensuring equitable reimbursement for participating physicians and hospitals. Conclusions: Health-policy makers need to advocate for better risk-adjustment methods to prevent the creation of financial disincentives for hospitals taking care of complex, sicker patients. Hospitals participating in bundled care also need to voice concerns regarding the grouping of hip fractures undergoing total hip arthroplasty to ensure that trauma centers are not unfairly penalized due to higher readmission rates associated with hip fractures skewing quality metrics. Physicians also need to consider the launch of better risk-stratification protocols and promote geriatric comanagement of these patients to prevent occurrences of costly adverse events.

show abstract

Evaluation of Factors Driving Cost Variation for Distal Radius Fracture Open Reduction Internal Fixation

Abstract: This study identifies modifiable factors that may lead to cost reduction for distal radius ORIF.

Cited by 34 publications

References 24 publications

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Evaluation of factors driving cost variation for distal humerus open reduction internal fixation

The “Hip Fracture” Bundle—Experiences, Challenges, and Opportunities

Contact Info

Product

Resources

About