Utilization and Costs of Postoperative Physical Therapy After Rotator Cuff Repair: A Comparison of Privately Insured and Medicare Patients

Arshi, Armin; Kabir, Nima Mohseni; Cohen, Jerome; Lord, Elizabeth L.; Wang, Jeffrey C.; McAllister, David R.; Petrigliano, Frank A.

doi:10.1016/j.arthro.2015.06.018

Cited by 34 publications

(35 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Alternatively, the adoption rates may reflect differences in resource utilization among the patient populations, given the possible higher costs associated with the arthroscopic approach 2 , 6 ; for example, it was demonstrated that patients with private health insurance are twice as likely as Medicare patients to undergo physical therapy after rotator cuff repair surgery. 3 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

Jensen

Peter

Devana

et al. 2017

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

Background:Medicare insures the largest population of patients at risk for rotator cuff tears in the United States.Purpose:To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients.Study Design:Cohort study; Level of evidence, 3.Methods:All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups.Results:In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01).Conclusion:In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

Jensen

Peter

Devana

et al. 2017

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the USA, between 200,000 and 300,000 rotator cuff tears are surgically repaired each year (Colvin, Harrison, Flatow, Egorova, & Moskowitz, 2012), at a cost of between $US10,000 and $US17,000 per surgery (Vitale et al, 2007); total annual expenditure in the USA is estimated at between $US3-12 billion dollars (McElvany, McGoldrick, Gee, Neradilek, & Matsen, 2015). Additional post-surgical rehabilitation costs of approximately $US3,000 per person (Arshi et al, 2015) mean that the total expenditure is considerable.…”

Section: Introductionmentioning

confidence: 99%

Rotator cuff repair protocols: A survey of current New Zealand practice

Harman¹,

Olds²

2017

NZJP

View full text Add to dashboard Cite

Rehabilitation following surgical rotator cuff repair may enable return to pre-injury function. Optimal recovery is facilitated by the use of post-operative protocols that enhance communication between the surgeon and physiotherapist. The purpose of this study was to describe the rotator cuff repair rehabilitation protocols currently used in New Zealand. Orthopaedic surgeons practising in New Zealand were contacted to determine their current rehabilitation protocols. Length of immobilisation and exercise progression following surgical repair were analysed across weekly timeframes from the day of surgery until nine months post-operatively. The response rate was 55% with protocols received from 31 surgeons. Post-surgical rotator cuff protocols currently in use in New Zealand are predominantly determined by weekly time periods which vary from surgeon to surgeon. Immobilisation was most commonly recommended for four to six weeks, pendular exercises were started the week of surgery, active exercises commenced at six weeks, followed by resisted exercises at twelve weeks. Few protocols based the rehabilitation upon tissue quality and size of rotator cuff tear. Level of detail regarding sets and repetitions of exercises also differed between protocols. Variability across protocols was evident regarding the recommended activity level and time period from surgery. Consideration of tissue quality, size of the tear and strength of the repair is recommended to facilitate optimal results.

show abstract

“…11,12 In addition to insurance status being significantly associated with perioperative outcomes in orthopedic procedures, 15 it has also been identified as a significant predictor of access to orthopedic surgical care and rehabilitation services. 7,8 Arshi et al . 8 retrospectively evaluated the utilization of PT after rotator cuff repair in privately insured and Medicare patients.…”

Section: Discussionmentioning

confidence: 99%

“…7 Most notably, Arshi et al reported that privately insured patients had better access to PT services after rotator cuff repair when compared to Medicare patients. 8 Similarly, we sought to determine the association of insurance status and access to therapy, comparing privately insured patients to a Medicaid population.…”

Section: Introductionmentioning

confidence: 99%

Insurance status affects access to physical therapy following rotator cuff repair surgery: A comparison of privately insured and Medicaid patients

et al. 2019

View full text Add to dashboard Cite

Rotator cuff repair (RCR) is an effective procedure to relieve shoulder pain and dysfunction. Postoperative physical therapy (PT) plays an integral role in the overall success of RCR. Insurance status has been shown to be an important predictor of postoperative PT utilization. This study evaluated the effect of insurance status on access to PT services following RCR. One hundred thirty-eight PT clinics were contacted in the Greater Boston metropolitan area. Clinics were contacted on two separate occasions and presented with a fictitious acutely postoperative RCR patient in need of PT. Insurance status was reported as Medicaid or private insurance. Overall, 133 (96.4%) accepted private insurance, whereas only 71 (51.4%) accepted Medicaid (P=0.019). Medicaid patients were offered a first available appointment at a mean of 8.3 days (95% CI: 7.13-9.38, range: 0-31) versus a mean of 6.3 days (95% CI: 5.3-7.22, range: 0-19, P=0.001) for private patients. Clinic location was not associated with access to PT or time to first appointment. Insurance status affects access to PT services and time to first available appointment in patients following RCR surgery in a major metropolitan area.

show abstract

Utilization and Costs of Postoperative Physical Therapy After Rotator Cuff Repair: A Comparison of Privately Insured and Medicare Patients

Cited by 34 publications

References 36 publications

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

Rotator cuff repair protocols: A survey of current New Zealand practice

Insurance status affects access to physical therapy following rotator cuff repair surgery: A comparison of privately insured and Medicaid patients

Contact Info

Product

Resources

About