OTA 2012 Posters

Scientific Poster #25 Hip/Femur OTA-2012

Are Dedicated Geriatric Hip Fracture Centers Justified Economically?

R. Carter Clement, MD, MBA; Jaimo Ahn, MD, PHD; Samir Mehta, MD;
Michael Maiale, MBA; Joseph Bernstein, MA, MD;
University of Pennsylvania Department of Orthopaedics, Philadelphia, Pennsylvania, USA

Purpose: The management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that the investment necessary to develop such a center is not perceived as financially worthwhile. The purpose of this study is to determine the economic justification for establishing dedicated hip fracture centers (HFCs).

Methods: A financial model was built to estimate profit as a function of costs, reimbursement, and patient volume in three settings: an average U.S. hip fracture program, an especially efficient center, and an academic hospital without a specific hip fracture program. Data sources included published series, government reports, and cost reports at our institution. Results were tested with sensitivity analyses. Lastly, a local market analysis was conducted to assess the feasibility of supporting dedicated hip fracture centers at volumes necessary for profitability.

Results: Hip fracture treatment generates economic losses at low volumes. Such care becomes profitable when the annual caseload exceeds 72, assuming costs characteristic of a typical HFC. The threshold of profitability is 49 cases/year for a low-cost HFC and 151 for an academic hospital. The largest determinant of profit is reimbursement, followed by costs and volume. In our home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Only 7 hospitals (4%) treated at least 151 hip fractures.

Conclusion: HFCs can be profitable, provided the center has a sufficiently large patient volume. However, most hospitals lack this volume and are likely losing money by offering hip fracture care. Thus, most hospitals would benefit financially from the consolidation of hip fracture care at dedicated regional HFCs. Most U.S. metropolitan areas have adequate volume to allow several such centers to operate profitably. The implications of HFCs for surgeons is not addressed by this analysis, but is worthy of future consideration as well.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.