Financial Implications for the Treatment of Medicare Patients With Isolated Intertrochanteric Femur Fractures: Disproportionate Losses Among Healthier Patients

Abstract

Introduction: With an aging American public, the rising incidence of geriatric hip fractures provides a significant impact on the financial sustainability for hospitals. To date, there is little research comparing reimbursement to hospital costs for geriatric hip fracture treatment. The purpose of this study is to compare hospital costs to reimbursement for patients treated surgically with an isolated intertrochanteric femur fracture, insured by the Center of Medicare and Medicaid Services (CMS). Materials and Methods: A retrospective review at an urban, academic, level 1 trauma center was conducted for 287 CMS-insured intertrochanteric femur fracture patients between 2013 and 2017. The total cost of care was determined using our hospital’s cost accounting system. The total reimbursement was determined from the CMS inpatient prospective payment system, based upon the Medical-Severity Diagnosis-Related Grouping (MS-DRG). Results: In this patient population, the average CMS reimbursement was US$19 049 ± 7221 and the average cost of care was US$19 822 ± 8078. This yielded a net deficit of US$773/patient and US$220 417 in total. The average reimbursement and cost for the less comorbid patients (MS-DRG weight < 2.5, n = 215) was US$16 198 ± 3983 and US$17 764 ± 5628, respectively, yielding an average net deficit of US$1566/patient. For the more comorbid patients (MS-DRG weight > 2.5, n = 72) the mean reimbursement and cost were US$27 796 ± 3944 and US$26 180 ± 10 880, respectively, yielding an average net profit of US$1616/patient. Discussion: There are disproportionate average losses in healthier patients undergoing surgical treatment of intertrochanteric femur fractures at our institution. A deficit in less comorbid patients indicates a discontinuity of inpatient health-care costs with MS-DRG-weighted reimbursement in the setting of geriatric intertrochanteric femur fractures. Conclusions: To maintain hospitals’ financial sustainability and health-care accessibility; costing and reimbursement models need adjusting to properly compensate the treatment of geriatric intertrochanteric femur fractures. Level of Evidence: Diagnostic level IV.

Diagnosis‐Related Group (DRG)‐Based Prospective Hospital Payment System can be well adopted for Acute Care Surgery: Taiwanese Experience with Acute Cholecystitis

“…Similar conclusions can be found in the literature for other diseases [27]. In one study regarding the treatment of intertrochanteric femur fractures, there was a net pro t for treating more comorbid patients but a net de cit for treating healthier patients [28]. Likewise, our results also showed that patients in DRG-2 (with comorbidities) had higher margins per patient than those in DRG-1 (without comorbidities).…”

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

“…Although this strategy allowed for more valid statistical conclusions and illuminated potential future studies that can be more targeted, more studies consisting of individual chart review to more accurately assess costs and outcomes at varying institutions that participate in the bundle. For example, Kelley et al 25 demonstrated this by doing a cost analysis on 278 individual patients that all had a similar intertrochanteric femur fracture at a single level 1 trauma center. They found that there indeed was a problematic and non-sustainable financial imbalance between the cost of highly comorbid patients and CMS reimbursements.…”

Trend and Economic Implications of Implant Selection in the Treatment of Intertrochanteric Hip Fractures: A Review of the American Board of Orthopaedic Surgery Database From 2007 to 2017

“…1 This incidence is increasing, creating a financial burden on the healthcare system, which has been estimated at $6 billion USD per year. [2][3][4][5][6][7][8] Surgical management continues to be the mainstay of treatment for IT fractures, with surgical implants and techniques evolving over the past 2 decades.…”