Medicare Compensation Rates for Hand and Shoulder/ Elbow Surgery by Operative Time: A Comparative Analysis | ||
| The Archives of Bone and Joint Surgery | ||
| مقاله 8، دوره 8، شماره 2، خرداد 2020، صفحه 173-183 اصل مقاله (645.28 K) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2019.39965.2072 | ||
| نویسندگان | ||
| Suresh K. Nayar* 1؛ Samir Sabharwal1؛ Keith T. Aziz1؛ Umasuthan Srikumaran1؛ Aviram M. Giladi2؛ Dawn M. LaPorte1 | ||
| 1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA | ||
| 2Curtis National Hand Center, Union Memorial Hospital, Baltimore, MD, USA | ||
| چکیده | ||
| Background: There is a high demand for shoulder/elbow experience among hand-fellowship trainees due to the perception that this exposure will improve their professional “marketability” in a subspecialty they perceive as having higher compensation. Methods: Using Medicare data, we investigated the most common surgeries from these fields and determined which have the highest compensation [work relative value unit (wRVU), payment, charge, and reimbursement (payment-to-charge percentage] rates per operative time. We then determined whether the overall non-weighted and weighted (by surgical frequency/volume) compensation rates of shoulder/elbow surgery are greater than that of hand surgery. Results: Among 30 shoulder/elbow procedures, arthroplasty and arthroscopic rotator cuff repair had the highest payment and wRVU assignments. Among 83 hand procedures, upper-extremity flaps, carpal stabilization, distal radius open reduction internal fixation (ORIF), both-bone ORIF, and interposition arthroplasty had the greatest wRVU assignments with correspondingly high payments. A non-weighted comparison of the two subspecialties showed that hand surgery has a higher mean payment/min ($10.46±3.22 vs. $7.52±2.89), charge/min ($51.02±17.11 vs. $41.96±11.32), and reimbursement (21±4.7% vs. 18±5.1%) compared with shoulder/elbow surgery (all, p <0.01). Non-weighted mean wRVUs/min were similar (0.12±0.03 vs. 0.13±0.03, P = 0.12). When weighted by procedure frequency, hand surgery had greater wRVUs/min (0.15±0.036 vs. 0.13±0.032), payments/min ($14.17±4.50 vs. $6.97±2.26), charges/min ($75.68±30.47 vs. $42.61±7.83), and reimbursement (20±5.0% vs. 17±6.0%) (all, p <0.01). Conclusion: According to Medicare compensation, and when weighted by procedure frequency, hand procedures are associated with greater overall mean wRVUs/min, payments/min, charges/min, and reimbursement compared with shoulder and elbow procedures. Hand-surgery fellowship applicants should be aware that subspecialty compensation is complex in nature but should seek shoulder/elbow elective experience to acquire an additional surgical skill-set as opposed to primarily monetary reason. Level of evidence: III | ||
| کلیدواژهها | ||
| Centers for medicare and medicaid Services؛ Compensation؛ Hand surgery؛ Payment؛ Reimbursement؛ Shoulder/elbow surgery؛ wRVU | ||
| مراجع | ||
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