Summary

Because medicare patients are older, we hypothesized that arthroscopic rotator cuff repairs could be costlier to fix arthroscopically, but there was no statistically significant difference in number of suture anchors used, implant cost, surgical duration, or overall cost of the procedure between Medicare cases and other insurers.

Abstract

Introduction

Cost containment is becoming paramount in providing financial and performance accountability for episodes of care. In this study, the direct cost of outpatient arthroscopic rotator cuff repair setting was assessed, comparing Medicare-insured patients to patients insured by other payors.

Methods

One hundred eighty four outpatient arthroscopic rotator cuff repairs performed by 5 fellowship-trained arthroscopic surgeons were reviewed. Operative time, number and cost of implants, hospital reimbursement, surgeon reimbursement, and insurance type were determined from billing records and operative reports. Patients were stratified by payor (Medicare versus non-Medicare), and these variables were compared.

Results

There was no statistically significant difference in number of suture anchors used, implant cost, surgical duration, or overall cost of the procedure between Medicare cases and other insurers. Reimbursement was significantly higher for other payors when compared to Medicare. An average operating loss of $263.54 was observed for the hospital in Medicare cases.

Discussion

In our hospital system, there was no statistically significant differences in implant cost, OR time, or total cost of procedure when comparing Medicare patients undergoing arthroscopic rotator cuff surgery to patients with other insurance. Further research needs to be conducted to establish proper rates and patient specific factors for bundled payments.