Study Finds Increases in Hospital Charges Responsible for Rising Cost of Hip Fracture Surgery

Brian Werner, MD

New research is shedding light on the reasons for increased costs associated with treating hip fractures.

Despite improvements in care resulting in shorter length of stays, the cost of surgical fixation of hip fractures has increased and the current analysis suggests the rise in cost is linked to increases in hospital charges and payments.

“The results confirm our hypothesis that hospital charges and payments contribute significantly more to the increasing cost of treating a hip fracture patient than surgeon charges and payments do," wrote investigators.

Led by Brian Werner, MD, a team from the University of Virginia Health sought to assess trends and variations in hospital charges and payment relative to surgeon charges and payments for surgical treatment of hip fractures using data from the PearlDiver database, which contains data related to fee-for-use administrative claims and provides a nationally representative sample of 51 million patients covered by Medicare parts A and B. Using ICD-9 and CPT codes, investigators identified 3028 patients who underwent closed reduction and percutaneous pinning (CRPP) and 25,341 patients who underwent open reduction internal fixation (ORIF) or intramedullary nail (IMN) from 2005-2014.

Of note, from PearlDiver investigators were also able to obtain information related to patient demographics, 90-day and one-year mortality, Charlson Comorbidity Index (CCI), and length of stay (LOS). Investigators calculated the ratio of hospital to surgeon charges (Charge multiplier: CM) and the ratio of hospital to surgeon payments (Payment multiplier: PM) for each year and region to assess trends over time. For the purpose of analysis, correlations between CM and PM and LOS were evaluated using a Pearson correlation coefficient.

Initial analysis indicated the number of CRPPs for femoral neck fracture performed annually remained relatively constant over the study period. Of note, when assessing patient characteristics, investigators found CCI increased from 6.0 in 2005 to 7.8 in 2014 (P=.033). Further analysis indicated these patients saw decreases in mean LOS (3.2 days in 2005 vs 2.8 days in 2014; P=.001), 90-day in-hospital mortality (2.5% in 2005 vs 1.54% in 2014), and 1-year in-hospital mortality (5.63% vs 2.16%) over the study period.

When assessing changes in cost, investigators found the CM for CRPP increased from 10.1 in 2005 to 15.6 in 2014 (P <.0001) while the PM for CRPP increased from 15. To 19.2 (P <.0001). Among patients undergoing ORIF/IMN, investigators found CM increased from 11.9 in 2005 to 17.2 in 2014 (P <.0001) while PM increased from 11.5 in 2005 to 17.4 in 2014 (P <.0001).

"Identifying and rectifying the sources of increased hospital charges – rather than continually minimizing surgeon reimbursement – will be tantamount to minimizing the financial burden of hip fractures on the health care system while continuing to deliver effective and efficient patient care in the coming years."

This study. “Increased Reimbursement for Surgical Fixation of Hip Fractures: The Difference between the Hospital and the Surgeon,” was published in the Journal of Orthopedic Trauma.