The effect of an orthopedic specialty hospital on operating room efficiency in shoulder arthroplasty

Padegimas, Eric M.; Hendy, Benjamin A.; Chan, Wayne W.; Lawrence, Cassandra; Cox, Ryan M.; Namdari, Surena; Lazarus, Mark D.; Williams, Gerald R.; Ramsey, Matthew L.; Horneff, John G.

doi:10.1016/j.jse.2018.06.035

Cited by 14 publications

(39 citation statements)

References 27 publications

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“…Though there are limited data regarding surgical volume and costs, one previous study has shown that there are real differences in OR efficiency between orthopedic specialty hospitals and tertiary medical centers, which may correspond to lower personnel costs. 22 The financial implications of a higherefficiency OR are unknown, but this would suggest that higher-volume orthopedic specialty hospitals would have lower personnel costs in the OR. 22 All 4 institutions in this study, though, are considered efficient, high-volume orthopedic centers.…”

Section: Discussionmentioning

confidence: 99%

“…22 The financial implications of a higherefficiency OR are unknown, but this would suggest that higher-volume orthopedic specialty hospitals would have lower personnel costs in the OR. 22 All 4 institutions in this study, though, are considered efficient, high-volume orthopedic centers. All 4 had previously taken the initiative to maximize value by tracking costs with TDABC methodology.…”

Section: Discussionmentioning

confidence: 99%

“…All 4 institutions are generally considered high-volume, efficient institutions. 10,18,22 Three of these institutions, Rothman Orthopaedic Specialty Hospital (Bensalem, PA, USA), Physicians Care Surgical Hospital (Limerick, PA, USA), and New England Baptist Hospital (Boston, MA, USA), are private surgical hospitals in the northeastern United States, whereas the remaining institution, Gundersen Health System (La Crosse, WI, USA) is a private medical center in the Midwest. All 4 institutions had previously and independently elected to track costs and maximize value through collaboration with AGH and were selected for participation because of this affiliation.…”

Section: Methodsmentioning

confidence: 99%

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Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study

Carducci

Mahendraraj

Menendez

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Despite rapid increases in the demand for total shoulder arthroplasty, data describing cost trends are scarce. We aim to (1) describe variation in the cost of shoulder arthroplasty performed by different surgeons at multiple hospitals and (2) determine the driving factors of such variation. Methods: A standardized, highly accurate cost accounting method, time-driven activity-based costing, was used to determine the cost of 1571 shoulder arthroplasties performed by 12 surgeons at 4 high-volume institutions between 2016 and 2018. Costs were broken down into supply costs (including implant price and consumables) and personnel costs, including physician fees. Cost parameters were compared with total cost for surgical episodes and case volume. Results: Across 4 institutions and 12 surgeons, surgeon volume and hospital volume did not correlate with episode-of-care cost. Average cost per case of each institution varied by factors of 1.6 (P ¼ .47) and 1.7 (P ¼ .06) for anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA), respectively. Implant (56% and 62%, respectively) and personnel costs from checkin through the operating room (21% and 17%, respectively) represented the highest percentages of cost and highly correlated with the cost of the episode of care for TSA and RSA. Conclusions: Variation in episode-of-care total costs for both TSA and RSA had no association with hospital or surgeon case volume at 4 high-volume institutions but was driven primarily by variation in implant and personnel costs through the operating room. This analysis does not address medium-or long-term costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study

Carducci

Mahendraraj

Menendez

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…Studies in lumbar decompression, total shoulder arthroplasty, and total ankle arthroplasty have shown similar results. 5,9,24 Patients undergoing procedures at the OSH resulted in lower post-trigger reimbursement, although this finding was not statistically significant. This comprises post-discharge reimbursements including for skilled nursing facility, rehabilitation facility, and outpatient physical therapy.…”

Section: Discussionmentioning

confidence: 91%

Reimbursement of Lumbar Decompression at an Orthopedic Specialty Hospital Versus Tertiary Referral Center

Kothari

Canseco

Karamian

et al. 2021

Spine

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Study Design. Retrospective cohort study.Objective. The aim of this study was to investigate the differences in Medicare reimbursement for one-to three-level lumbar decompression procedures performed at a tertiary referral center versus an orthopedic specialty hospital (OSH). Summary of Background Data. Lumbar decompression surgery is one of the most commonly performed spinal procedures. Lumbar decompression also comprises the largest proportion of spinal surgery that has transitioned to the outpatient setting. Methods. Patients who underwent a primary one-to three-level lumbar decompression were retrospectively identified. Reimbursement data for a tertiary referral center and an OSH were compiled through Centers for Medicare and Medicaid Services. Demographic data, surgical characteristics, and time cost data were collected through chart review. Multivariate regression models were used to determine independent factors associated with total episode of care cost, operating room (OR) time, procedure time, and length of stay (LOS), and to determine independent predictors of having the decompression performed at the OSH. Results. Total episode of care, facility, and non-facility payments were significantly greater at the tertiary referral center than the OSH, as were OR time for one-to three-level procedures, procedure time of all pooled levels, and LOS for one-and two-level procedures. Three-level procedure was independently associated with increased OR time, procedure time, and LOS. Age and two-level procedure were also associated with increased LOS. Procedure at the OSH was associated with decreased OR time and LOS. Charlson Comorbidity Index was a negative predictor of decompression being performed in the OSH setting. Conclusion. Significant financial savings to health systems can be expected when performing lumbar decompression surgery at a specialty hospital as opposed to a tertiary referral center. Patients who are appropriate candidates for surgery in an OSH can in turn expect faster perioperative times and shorter LOS.

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“…This will create an environment where the entire staff is more specialized in the specific specialty of interest. A study done by Padegimas, et al 2018, found that the operating room efficiency was far greater in an orthopedic specialty hospital versus a tertiary referral center [8].…”

Section: Advantagesmentioning

confidence: 98%

What is the Ideal Neurosurgical or Orthopedic Specialty Hospital?

Sukhbir¹,

M²

2020

J Orthop Surg Tech

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When creating a Specialty Hospital, we must acknowledge that there are advantages and disadvantages. The advantages are sometimes the easiest standpoint to differentiate and potentially make this venture the most acceptable and profitable. Disadvantages may come about from different variables which could bring inefficiencies or increased expenditures. In addition to advantages and disadvantages, we also must look at stressors political, socio-cultural and competition [2], which may affect the development and ex-

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The effect of an orthopedic specialty hospital on operating room efficiency in shoulder arthroplasty

Cited by 14 publications

References 27 publications

Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study

Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study

Reimbursement of Lumbar Decompression at an Orthopedic Specialty Hospital Versus Tertiary Referral Center

What is the Ideal Neurosurgical or Orthopedic Specialty Hospital?

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