Sat., 10/10/09 Basic Sci./Injury Prevent./Spine, Paper #75, 11:41 am OTA-2009
Financial Implications of Non-Operative Fracture Care at an Academic Trauma Center
Paul Appleton, MD (n);
Edward K. Rodriguez MD (5A-Regenisys Orthopaedics; 8-MXO Orthopaedics);
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Purpose: The current medical-economic crisis has placed a financial burden on both hospitals and health care professionals. Decreased external funding and reimbursements have placed additional stress on maintaining financially viable academic trauma practices with the goals of providing quality patient care, resident education, and research. Our hypothesis was that nonsurgical procedures and consults generated a significant portion of annual revenues in an academic practice.
Method: A review was undertaken of billings/collections from fiscal year 2008 for an academic trauma practice. The hospital is an urban Level 1 trauma center with 2 trauma fellowship-trained orthopaedic surgeons with the weekend support of 6 additional nontrauma subspecialty surgeons. The trauma service is responsible for the care of approximately 1,200 patients a year. An analysis was made of relative value units (RVUs) generated by operative and nonoperative care, separating the latter into clinic, consults, and closed (nonoperative) fracture treatment.
Results: A total of 19,815 RVUs were generated by the trauma service during the 2008 fiscal year. Emergency department and ward consults generated 2,176 RVUs (11%), while outpatient clinic generated an additional 1,313 RVUs (7%). Nonoperative (closed) fracture care generated 2,725 RVUs (14%), while surgical procedures were responsible for the remaining 13,490 RVUs (68%). An analysis of the nonoperative fracture cases revealed that pubic ramus, proximal humerus, and distal radius fractures accounted for 43% of RVUs (1,179) generated. In terms of overall financial reimbursement, nonoperative management, consults, and office visits generated 31% of income for the trauma service.
Conclusion: While the largest financial contribution to a busy surgical practice is operative procedures, one must not overlook the important impact of nonoperative fracture care and consults. In our academic center, nearly one-third of all income was generated from nonsurgical procedures. In the current medical/financial climate, one must be diligent in optimizing the finances of trauma care in order to sustain an economically viable practice.
• 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