Trends in Distal Radius Fixation Reimbursement, Charge, and Utilization in the Medicare Population

Abstract

Background Distal radius fractures (DRF) are the second most common fragility fracture experienced by the elderly, and surgical management constitutes an appreciable sum of Medicare expenditure for upper extremity surgery. Using Medicare data from 2012 to 2017, our primary aim was to describe temporal changes in surgical treatment, physician payment, and patient charges for DRF fixation. Methods We examined surgical volumes and retrospective patient charge (services billed by surgeon) and surgeon payment (professional fee) data from 2012 to 2017 for four DRF surgeries: closed reduction percutaneous pinning (CRPP), open reduction internal fixation (ORIF) of extra-articular fractures, ORIF of intra-articular (IA) (2-fragment) fractures, and ORIF of IA (> 3 fragments) fractures. The reimbursement ratio was defined and calculated as the ratio of charges to payment. Rates were adjusted for inflation using the annual consumer-price index. Results For these four surgeries from 2012 to 2017, total patient charges grew by 64% from $117 to 193 million, while surgeon payment grew by 42% from $30 to 42 million. CRPP cases fell by 47%, while ORIF increased by 17, 14, and 45% for extra-articular, IA (2-fragment), and IA (> 3 fragments) surgeries, respectively. After adjusting for inflation, payment to physicians increased by more than or equal to 16% for all procedures except for CRPP, which fell by 2%. Charges during this same period increased from 13 to 38%. Reimbursement ratios declined from -9.2% to -13% for each procedure. Conclusion From 2012 to 2017, while charges have outpaced surgeon payment, payment has outpaced inflation for all forms of distal radius ORIF, aside from CRPP. There has been a continued sharp decline of CRPP. Level of Evidence is III, economic.

Keywords: closed reduction percutaneous fixation; distal radius fracture; patient charges; surgeon payment; volar plates.

Fig. 1

Total Medicare patient charges for distal radius fixation procedures from 2012 to 2017. R ² shows linear regression strength of trend. CRPP, closed reduction percutaneous pinning; EA, extra-articular; IA, intra-articular; ORIF, open reduction internal fixation.

Fig. 2

Total Medicare surgeon payment for distal radius fixation procedures from 2012 to 2017 . R ² shows linear regression strength of trend. CRPP, closed reduction percutaneous pinning; EA, extra-articular; IA, intra-articular; ORIF, open reduction internal fixation.

Fig. 3

Total number of Medicare distal radius fixation procedures from 2012 to 2017. R ² shows linear regression strength of trend. CRPP, closed reduction percutaneous pinning; EA, extra-articular; IA, intra-articular; ORIF, open reduction internal fixation.

Fig. 4

Total number of unique surgeons performing Medicare distal radius fixation from 2012 to 2017. R ² shows linear regression strength of trend. CRPP, closed reduction percutaneous pinning; EA, extra-articular; IA, intra-articular; ORIF, open reduction internal fixation.

Fig. 5

Inflation-adjusted Medicare patient charges (blue) and surgeon payment (red) rates for four types of distal radius fixation from 2012 to 2017. Note the relatively larger growth of submitted charges compared with payment. Linear regression (R ² ) shown at the top right corner of respective charge or payment line. CRPP, closed reduction percutaneous pinning; EA, extra-articular; IA, intra-articular; ORIF, open reduction internal fixation.

Fig. 6

Medicare changes in surgeon payment and surgical volume for distal radius fixation procedures from 2012 to 2017. CRPP, closed reduction percutaneous pinning; EA, extra-articular; IA, intra-articular; ORIF, open reduction internal fixation.