Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Primary versus revision total shoulder arthroplasty: comparing relative value and reimbursement trends

  • Received : 2021.08.25
  • Accepted : 2021.10.04
  • Published : 2022.03.01
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Abstract

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05. Results: When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions: The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.

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References

  1. Roberson TA, Bentley JC, Griscom JT, et al. Outcomes of total shoulder arthroplasty in patients younger than 65 years: a systematic review. J Shoulder Elbow Surg 2017;26:1298-306. https://doi.org/10.1016/j.jse.2016.12.069
  2. Cuff DJ, Pupello DR. Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg Am 2013; 95:2050-5. https://doi.org/10.2106/JBJS.L.01637
  3. Osterhoff G, O'Hara NN, D'Cruz J, et al. A cost-effectiveness analysis of reverse total shoulder arthroplasty versus hemiarthroplasty for the management of complex proximal humeral fractures in the elderly. Value Health 2017;20:404-11. https://doi.org/10.1016/j.jval.2016.10.017
  4. Austin DC, Torchia MT, Cozzolino NH, Jacobowitz LE, Bell JE. Decreased reoperations and improved outcomes with reverse total shoulder arthroplasty in comparison to hemiarthroplasty for geriatric proximal humerus fractures: a systematic review and meta-analysis. J Orthop Trauma 2019;33:49-57. https://doi.org/10.1097/BOT.0000000000001321
  5. Stanbury SJ, Voloshin I. Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: a review of the literature. Geriatr Orthop Surg Rehabil 2011;2:181-6. https://doi.org/10.1177/2151458511420140
  6. Craig RS, Goodier H, Singh JA, Hopewell S, Rees JL. Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy. Cochrane Database Syst Rev 2020;4:CD012879.
  7. Hyun YS, Huri G, Garbis NG, McFarland EG. Uncommon indications for reverse total shoulder arthroplasty. Clin Orthop Surg 2013;5:243-55. https://doi.org/10.4055/cios.2013.5.4.243
  8. Dillon MT, Chan PH, Inacio MC, Singh A, Yian EH, Navarro RA. Yearly trends in elective shoulder arthroplasty, 2005-2013. Arthritis Care Res (Hoboken) 2017;69:1574-81. https://doi.org/10.1002/acr.23167
  9. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am 2011;93:2249-54. https://doi.org/10.2106/JBJS.J.01994
  10. Wagner ER, Farley KX, Higgins I, Wilson JM, Daly CA, Gottschalk MB. The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. J Shoulder Elbow Surg 2020;29:2601-9. https://doi.org/10.1016/j.jse.2020.03.049
  11. Best MJ, Aziz KT, Wilckens JH, McFarland EG, Srikumaran U. Increasing incidence of primary reverse and anatomic total shoulder arthroplasty in the United States. J Shoulder Elbow Surg 2021;30:1159-66. https://doi.org/10.1016/j.jse.2020.08.010
  12. Charles MD, Cvetanovich G, Sumner-Parilla S, Nicholson GP, Verma N, Romeo AA. Outpatient shoulder arthroplasty: outcomes, complications, and readmissions in 2 outpatient settings. J Shoulder Elbow Surg 2019;28(6S):S118-23. https://doi.org/10.1016/j.jse.2019.04.006
  13. Bedeir YH, Gawish HM, Grawe BM. Outcomes of reverse total shoulder arthroplasty in patients 60 years of age or younger: a systematic review. J Hand Surg Am 2020;45:254.e1-254.e8. https://doi.org/10.1016/j.jhsa.2019.06.009
  14. Savin DD, Frank RM, Sumner S, Richardson C, Nicholson GP, Romeo AA. Good functional outcomes expected after shoulder arthroplasty irrespective of body mass index. J Shoulder Elbow Surg 2018;27:S43-9. https://doi.org/10.1016/j.jse.2018.03.022
  15. Somerson JS, Hsu JE, Neradilek MB, Matsen FA 3rd. Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016. J Shoulder Elbow Surg 2018;27:1978-86. https://doi.org/10.1016/j.jse.2018.03.025
  16. Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 2011;19:439-49. https://doi.org/10.5435/00124635-201107000-00007
  17. Newman JM, Stroud SG, Yang A, et al. Total shoulder arthroplasty in octogenarians: is there a higher risk of adverse outcomes. J Orthop 2018;15:671-5. https://doi.org/10.1016/j.jor.2018.05.035
  18. Franklin JL, Barrett WP, Jackins SE, Matsen FA 3rd. Glenoid loosening in total shoulder arthroplasty: association with rotator cuff deficiency. J Arthroplasty 1988;3:39-46. https://doi.org/10.1016/S0883-5403(88)80051-2
  19. Valenti P, Kilinc AS, Sauzieres P, Katz D. Results of 30 reverse shoulder prostheses for revision of failed hemi- or total shoulder arthroplasty. Eur J Orthop Surg Traumatol 2014;24:1375-82. https://doi.org/10.1007/s00590-013-1332-9
  20. Papadonikolakis A, Neradilek MB, Matsen FA 3rd. Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am 2013;95:2205-12. https://doi.org/10.2106/JBJS.L.00552
  21. Centers for Medicare & Medicaid Services. Final policy, payment, and quality provisions changes to the medicare physician fee schedule for calendar year 2021 [Internet]. Baltimore, MD: Centers for Medicare & Medicaid Services; 2020 [cited 2021 Mar 9]. Available from: https://www.cms.gov/newsroom/factsheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1.
  22. Nayar SK, Aziz KT, Zimmerman RM, Srikumaran U, LaPorte DM, Giladi AM. Misvaluation of hospital-based upper extremity surgery across payment, relative value units, and operative time. Iowa Orthop J 2020;40:173-83.
  23. Sodhi N, Piuzzi NS, Khlopas A, et al. Are we appropriately compensated by relative value units for primary vs revision total hip arthroplasty. J Arthroplasty 2018;33:340-4. https://doi.org/10.1016/j.arth.2017.09.019
  24. Orr RD, Sodhi N, Dalton SE, et al. What provides a better value for your time? The use of relative value units to compare posterior segmental instrumentation of vertebral segments. Spine J 2018;18:1727-32. https://doi.org/10.1016/j.spinee.2018.01.026
  25. Peterson J, Sodhi N, Khlopas A, et al. A comparison of relative value units in primary versus revision total knee arthroplasty. J Arthroplasty 2018;33:S39-42. https://doi.org/10.1016/j.arth.2017.11.070
  26. Sodhi N, Yao B, Newman JM, et al. A comparison of relative value units in primary versus revision total ankle arthroplasty. Surg Technol Int 2017;31:322-6.
  27. Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012;215:453-66. https://doi.org/10.1016/j.jamcollsurg.2012.06.017
  28. Alluri RK, Leland H, Heckmann N. Surgical research using national databases. Ann Transl Med 2016;4:393. https://doi.org/10.21037/atm.2016.10.49
  29. Kim L, Mabry C, Klimberg VS. Quality of benchmarks for assessment of care will influence outcome. Ann Surg 2007;245:672-3. https://doi.org/10.1097/01.sla.0000261457.12706.5c
  30. Feng JE, Anoushiravani AA, Schoof LH, et al. Barriers to revision total hip service lines: a surgeon's perspective through a deterministic financial model. Clin Orthop Relat Res 2020;478: 1657-66. https://doi.org/10.1097/CORR.0000000000001273
  31. Schwartz DA, Hui X, Velopulos CG, et al. Does relative value unit-based compensation shortchange the acute care surgeon. J Trauma Acute Care Surg 2014;76:84-92. https://doi.org/10.1097/ta.0b013e3182ab1ae3
  32. Doval AF, Nguyen-Lee JJ, Beal LL, Zheng F, Echo A. Does complexity relate to compensation? A comparison of relative value units in initial versus recurrent inguinal hernia repair. Hernia 2020;24:245-50. https://doi.org/10.1007/s10029-019-02020-9
  33. Sheils CR, Dahlke AR, Kreutzer L, Bilimoria KY, Yang AD. Evaluation of hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Surgery 2016;160:1182-8. https://doi.org/10.1016/j.surg.2016.04.034