Understanding the costs of surgical care and the drivers of those costs is necessary for moving toward providing value-based musculoskeletal care. This research showed see how common medical comorbidities and specific total elbow arthroplasty (TEA) indications affected reimbursement costs throughout a 90-day TEA episode. The secondary goal was to figure out what was causing these charges. From a commercially available national database of 53 million individuals, administrative health claims for orthopedic intervention patients between 2010 and 2020 were queried using particular illness categorization and procedural terminology codes. Commercially insured patients were separated into distinct cohorts based on surgical indications and medical comorbidity. They assessed surgical encounters, 89-day postoperative period, and overall 90-day reimbursement expenses. They determined cost drivers for the first 89 days after surgery. For comparison, descriptive statistics and the Kruskal-Wallis test were used.

A total of 378 people were recognized as having undergone TEA. The average surgical encounter reimbursement cost ($13,393 ± $8,314) did not differ significantly based on patient variables. When stratified by surgical indication (p<0.0001) or medical comorbidity (p<0.0001), the mean reimbursement cost of the 89-day postoperative period ($4,232 ± $2,343) differed. The most expensive postoperative phase was revealed by the indication of rheumatoid arthritis ($4,864 ± $1,136) and the comorbidity of chronic kidney disease ($5,873 ± $1,165). When stratified by surgical indication (P=0.00083) or medical comorbidity (P<0.0001), the total 90-day reimbursement cost ($16,982 ± $4,132) differed significantly, with the indication of acute fracture ($18,870 ± $3,971) and the comorbidity of chronic pulmonary disease ($19,194 ± $3,829) demonstrating the most expensive total 90-day cost. Readmission-related inpatient charges accounted for 38% of the overall reimbursement cost. Overall, 5.0% of patients were readmitted, with a mean readmission cost of $16,296. 

Surgical indications and medical comorbidities during the postoperative period and the entire 90-day episode of treatment have a substantial impact on TEA reimbursements. The need for surgeons and policymakers to understand treatment costs associated with distinct patient-level characteristics will grow as the United States converts to value-based healthcare.

Source:www.jshoulderelbow.org/article/S1058-2746(22)00345-7/fulltext#relatedArticles