Medicare Spending and Evidence-Based Approach in Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: 2001 to 2010

Abstract

Background Despite equivalent outcomes among surgical treatments of thumb carpometacarpal (CMC) arthritis, little is known about variation in spending. Owing to its complexities, we hypothesized that trapeziectomy with ligament reconstruction and tendon interposition (LRTI) when compared to other surgical procedures incurs the greatest cost to Medicare. Methods Using a random 5% sample of Medicare beneficiaries diagnosed with thumb CMC arthritis, we examined total and out-of-pocket spending for 3,530 patients who underwent a surgical treatment, between 2001 and 2010. We used generalized linear regression models, controlling for patients’ characteristics and place of surgery to examine variation in spending. Results 89% of patients who underwent surgery received trapeziectomy with LRTI, with total and out-of-pocket spending of $2,576 (CI: $2,333 – $2,843, p < 0.001) and $436 (CI: $429 – $531, p < 0.001), respectively. Simple complete trapeziectomy was the least expensive procedure, performed only among 5% of patients, with total and out-of-pocket spending of $1,268 (CI: $1,089 – $1,476, p < 0.001) and $236 (CI: $180 – $258, p < 0.001), respectively. Owing to increasingly higher facility costs, performing the same procedure in a hospital outpatient setting compared with an ambulatory center would increase Medicare spending by more than two folds (p < 0.001). Conclusions With a consistent rise of healthcare spending, adherence to evidence-based approach in medicine is more important than ever. Most surgeons continue to perform trapeziectomy with LRTI, the most expensive surgical option. Medicare could potentially save $74 million annually if simple complete trapeziectomy was the procedure of choice.

Evidence-Based Practice in the Surgical Treatment of Thumb Carpometacarpal Joint Arthritis

“…Furthermore, the addition of prosthetic arthroplasty, and the increase in its utilization, may have been the result of higher physician reimbursement rates associated with the additional ligament reconstruction compared with simple trapeziectomy. 36 …”

Coding Practices in Hand Surgery and Their Relationship to Surgeon Compensation Structure

“…These charges to the health care system can quickly accumulate as this procedure is performed 80,000 times per year in the United States. 10 Poor coding practices, including upcoding and unbundling, are forms of coding fraud and can have detrimental effects on medical practices. Upcoding refers to submitting a CPT code for a procedure of higher reimbursement value than the actual procedure performed and is an unethical violation by Centers for Medicare and Medicaid Services guidelines.…”

“…These charges to the health care system can quickly accumulate as this procedure is performed 80,000 times per year in the United States. 10 …”

Nykščio riešinio sąnario artrozės gydymas atvirąja sinovektomija su sąnario išvalymu: vėlyvųjų pooperacinių gydymo rezultatų įvertinimas

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