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首页> 外文期刊>Clinical Orthopaedics and Related Research >Barriers to Revision Total Hip Service Lines: A Surgeon's Perspective Through a Deterministic Financial Model
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Barriers to Revision Total Hip Service Lines: A Surgeon's Perspective Through a Deterministic Financial Model

机译：修订的障碍总臀部服务线：外科医生通过确定性金融模型的观点

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Background Revision THA represents approximately 5% to 10% of all THAs. Despite the complexity of these procedures, revision arthroplasty service lines are generally absent even at high-volume orthopaedic centers. We wanted to evaluate whether financial compensation is a barrier for the development of revision THA service lines as assessed by RVUs. Questions/purposes Therefore, we asked: (1) Are physicians fairly compensated for revision THA on a per-minute basis compared with primary THA? (2) Are physicians fairly compensated for revision THA on a per-day basis compared with primary THA? Methods Our deterministic financial model was derived from retrospective data of all patients undergoing primary or revision THA between January 2016 and June 2018 at an academic healthcare organization. Patients were divided into five cohorts based on their surgical procedure: primary THA, head and liner exchange, acetabular component revision THA, femoral component revision THA, and combined femoral and acetabular component revision THA. Mean surgical times were calculated for each cohort, and each cohort was assigned a relative value unit (RVU) derived from the 2018 Center for Medicaid and Medicare assigned RVU fee schedule. Using a combination of mean surgical time and RVUs rewarded for each procedure, three models were developed to assess the financial incentive to perform THA services for each cohort. These models included: (1) RVUs earned per the mean surgical time, (2) RVUs earned for a single operating room for a full day of THAs, and (3) RVUs earned for two operating rooms for a full day of primary THAs versus a single rooms for a full day of revision THAs. A sixth cohort was added in the latter two models to more accurately reflect the variety in a typical surgical day. This consisted of a blend of revision THAs: one acetabular, one femoral, and one full revision. The RVUs generated in each model were compared across the cohorts. Results Compared with primary THA by RVU per minute, in revision THA, head and liner exchange demonstrated a 4% per minute deficit, acetabular component revision demonstrated a 29% deficit, femoral component revision demonstrated a 32% deficit, and full revision demonstrated a 27% deficit. Compared with primary service lines with one room, revision surgeons with a variety of revision THA surgeries lost 26% potential relative value units per day. Compared with a two-room primary THA service, revision surgeons lost 55% potential relative value units per day. Conclusions In a comparison of relative value units of a typical two-room primary THA service line versus those of a dedicated revision THA service line, we found that revision specialists may lose between 28% and 55% of their RVU earnings. The current Centers for Medicare and Medicaid Services reimbursement model is not viable for the arthroplasty surgeon and limits patient access to revision THA specialists.
机译：背景版本修订Tha代表了所有THA的约5％至10％。尽管这些程序的复杂性，即使在大容量骨科中心也通常不存在修复关节成形术服务。我们希望评估财务补偿是否是由RVU评估的修订版THA服务线的障碍。因此，提出问题/目的，我们询问：（1）与主要THA相比，医生是否适用于每分钟修订THA？ （2）与主要THA相比，医生是否对每日修订进行修订，对母亲进行修订？方法采用我们的确定性财务模型来自2016年1月至2018年1月至2018年6月在2016年1月至2018年6月在学术医疗保健组织之间进行的回顾性数据。基于外科手术的患者分为五个队列：初级THA，头部和衬垫交换，髋臼组分修订版THA，股骨组分修复素和组合股骨和髋臼组分修订。为每个群组计算平均手术时间，每个队列都分配了从2018年Medicaids和Medicare指定的RVU费用表中获得的相对价值单位（RVU）。使用平均手术时间和RVU的组合为每个程序奖励，开发了三种模型，以评估为每位队列执行THA服务的财务激励。这些型号包括：（1）根据平均手术时间赚取的RVU，（2）RVU为单一的手术室赢得了一整天的THA，（3）RVU为两个手术室赢得了一个整天的主要THA与一个房间，整天修改。在后两种模型中加入了第六队队列，以更准确地反映典型的外科手术日。这包括修订版的混合：一个髋臼，一个股骨和一个完全修订。在每个模型中产生的RVU在群组中进行了比较。结果与每分钟的RVU初级THA相比，在修订THA，头部和衬垫交换中显示出4％的每分钟赤字，髋臼成分修订表明，股骨成分修订表现出29％的赤字，并且完全修改证明了27％ ％赤字。与一个房间的主要服务线相比，具有各种修订的修订外科医生，每天丢失26％的相对价值单位。与双人初级服务的服务相比，修订外科医生每天损失55％的潜在相对价值单位。结论在典型的双人初级THA服务线与专用修订版的服务线相对价值单位的比较中，我们发现修订专家可能会损失其RVU收益的28％和55％。现有的医疗保险和医疗补助服务报销模式对于关节造身外科医生不可行，并限制患者对修订的专家。

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