Variation of the Inpatient Cost of Care in the Treatment of Isolated Geriatric Intertrochanteric Hip Fractures

Abstract

Introduction: Geriatric hip fractures are a major, costly public health issue, expected to increase in incidence and expense with the aging population. As healthcare transitions towards value-based care, understanding cost drivers of hip fracture treatment will be necessary to perform adequate risk adjustment. Historically, cost has been variable and difficult to determine. This study was purposed to identify variables that can predict the overall cost of care for geriatric intertrochanteric (IT) hip fractures and provide a better cost prediction to ensure the success of future bundled payment models. Methods: A retrospective review of operatively-managed geriatric hip fractures was performed at single urban level I academic trauma center between 2013 and 2017. Patient variables were collected via the electronic medical record (EMR) including CCI, ACCI, ASA, overall length of stay (LOS), AO/OTA fracture classification and demographics. Direct and indirect costs were calculated by activity-based costing by the hospital’s accounting software. Multivariable linear regression models evaluated which parameters predicted total inpatient cost of care. Results: The mean cost of care was $19,822, ranging from $9,128 to $64,211. Critical care comprised 16.9% of total costs, followed by implant costs (13.6%), and nursing costs (12.6%). Regression analysis identified both ASA ( p < 0.01) and ACCI ( p = 0.01) as statistically significant associative parameters, but only LOS ( r 2 = 0.77) as a strong correlative measure for inpatient care cost. Conclusion: This study found no correlation between ACCI or ASA and the total inpatient cost of care in isolated intertrochanteric geriatric hip fractures, suggesting that the inpatient episode-of-care costs cannot be accurately predicted by the patient demographics/comorbidities alone. Future bundled care payment models would have to be adjusted to account for variables beyond just patient characteristics. Level of Evidence: Diagnostic Level IV.

Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures

“…12 - 14 Although the National Readmissions Database does not record a total cost for a patient care episode in its entirety, these variables serve as a proxy for estimating increased cost to the care facility. It has previously been shown that length of stay is a strong correlative measure for inpatient cost care (R 2 = .77) 1 supporting our hypothesis of variance in cost within this bundle.…”

“…While this study is focused on the potential financial discrepancies between services provided and reimbursement, the National Readmission Database that was used for this dataset does not measure the true total cost of a bundle of care. Other data elements that have been shown to be accurate surrogates for cost such as readmission rate 8 and length of stay (R 2 = .77), 1 , 23 as well as others such as comorbidities and chronic diagnoses, were used to approximate expenses and the variety of costs when stratified with different approaches. Although the NRD lacks data from the post-acute perspective such as outpatient, home care, and skilled nursing facilities, this study focused on the hospital cost and readmission numbers.…”

“…Bundled reimbursements have become a flagship of CMS cost reduction efforts in recent years, and have increased in number to span multiple domains of patient care both medical and surgical. 1 …”

“…Bundled reimbursements have become a flagship of CMS cost reduction efforts in recent years, and have increased in number to span multiple domains of patient care both medical and surgical. 1 Although some Bundled Reimbursements in general have shown promise, more recent systemic reviews have raised concerns on the utilization and cost effectiveness of specific bundles, particularly those with significant patient population heterogeneity that require more in-depth risk stratification for accurate reimbursement. 2,3 A new Bundled Payment for Care Improvement-Advanced (BPCI-A) for surgical hip and femur fractures was initiated in 2016.…”

The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention

“…With an expected longevity of up to 20 years, a flooring intervention presents the opportunity for a significant return on investment [17][18][19][20]. If proven effective at preventing hip fractures for example (which have been estimated to incur upwards of USD 6500 per fracture to various international health systems, often considerably more [21][22][23]), the cost of purchasing and installing a new floor could be quickly recouped. Yet rarely do interventions come without risk, and for shock-absorbing flooring interventions the concerns are twofold: 1) the debated potential for a softer surface to inadvertently increase the risk of falling for those already unsteady on their feet [24][25][26][27][28][29][30][31][32][33][34][35]; and 2) the risk to staff who may find manoeuvring wheeled equipment (such as beds and trolleys) harder, due to greater resistance to pushing and pulling forces [36][37][38][39], potentially increasing the risk of musculoskeletal injuries [40,41].…”