Friday, February 3, 2017

Total shoulders - effect of co-morbidities on cost

Comorbidity effects on shoulder arthroplasty costs analysis of a nationwide private payer insurance data set

These authors sought to evaluate the effect of common medical comorbidities on the reimbursements of different shoulder arthroplasty procedures. They queried single private payer (Hamana) insurance claims database using the PearlDiver database.

They found that comorbidities did not have a significant effect on same-day reimbursements but instead caused a significant effect on the subsequent 89-day reimbursements.

In reverse total shoulders, the day of surgery reimbursements averaged 2/3rds of the 90 day reimbursement while the subsequent 89 days counted for 1/3. The subsequent 89 day reimbursement was highest for patients with hepatitis C and atrial fibrillation. The total 90 day reimbursement was 24% higher for patients with hepatitis C. 

Comment: As the authors point out, patients with hepatitis C have an increased risk for complications, including almost twice the rate of infection within the first three months after shoulder arthroplasty. These patients also have a higher risk of dislocation, fracture, revisions, systemic complications, and blood transfusions. These factors will obviously contribute to the increased 90 day reimbursement.

In this study costs were determined on the basis of reimbursement data from the insurance company to the payees, which includes costs of hospitalization, surgical procedure, physical therapy ad diagnostic tests. Hospital systems recognize that the reimbursement for a service is not the same as the cost of providing this service. These data were obtained from analysis of Humana as a single payer, a managed care environment that is controlled by negotiated proprietary contracts between hospitals and payers. The results of such a study are expected to be different for payers with a fixed reimbursement rate such as Medicare.


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