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

• Published in: Geriatric orthopaedic surgery & rehabilitation 2020, Vol.11, p.2151459320916947-2151459320916947
• Main Authors: Kelly, Brandon, Parikh, Harsh R., McCreary, Dylan L., McMillan, Logan, Horst, Patrick K., Cunningham, Brian P.
• Format: Article
• Language: English
• Subjects: Comorbidity; Fractures; Geriatrics; Hip Fracture Care for 2020: Best Care, Best Value; Hospital costs; Medicare; Patients; Prospective payment systems
• ISSN: 2151-4593; 2151-4585; 2151-4593
• DOI: 10.1177/2151459320916947

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.