Variation in inpatient hospital and physician payments among patients undergoing general versus orthopedic operations

Aslam Ejaz, Faiz Gani, Yuhree Kim, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background Comparative data on surgeon payments for operative procedures are not well documented. We sought to assess variations in surgeon payments after common general and orthopedic operations using a nationally representative sample of privately insured patients. Methods A total of 486,506 patients who underwent a general (appendectomy, cholecystectomy, colectomy) or orthopedic (total knee replacement, total hip replacement) operation between 2010–2012 were identified from the Truven Health MarketScan database. Results Median age was 54 years (general operation, 44 years vs orthopedic operation, 58 years; P < .001). Patients had an average Charlson Comorbidity Index of 0 (interquartile range [IQR]: 0, 1). Median duration of stay was 3 days (IQR: 2, 4) (general operation, 3 days [IQR: 1, 5] vs orthopedic operation, 3 days [IQR: 2, 3]; P < .001). Total hospital payments averaged $18,209 (IQR: $11,751, $26,598) (general operation: $12,744 [IQR: $8,402, $19,896] vs orthopedic operation: $22,386 [IQR: $16,888, $30,100]; P < .001). Median surgeon reimbursement was $1,923 (IQR: $1,146, $2,676), with orthopedic surgeon payments being on average twice as high as general surgeon payments ($2,349 vs $1,191; P < .001). Median surgeon payment varied among both general (appendectomy: $903 vs cholecystectomy: $1,125 vs colectomy: $2,209; P < .001) and orthopedic operations (total knee replacement: $2,282 vs total hip replacement: $2,392; P < .001). The presence of a postoperative complication resulted in an increase in hospital payments by 25% and surgeon payments by 11%. Conclusions Hospital and surgeon payments following routine general and orthopedic operations vary greatly. Patients with comorbid conditions and those who experienced a postoperative complication resulted in higher overall payments. Though significant variability existed at the surgeon level, hospital payments were responsible for the highest source of variability.

Original languageEnglish (US)
Pages (from-to)1657-1665
Number of pages9
JournalSurgery
Volume160
Issue number6
DOIs
StatePublished - Dec 1 2016

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Orthopedics
Inpatients
Physicians
Knee Replacement Arthroplasties
Appendectomy
Hip Replacement Arthroplasties
Colectomy
Cholecystectomy
Surgeons
Operative Surgical Procedures
Comorbidity
Databases
Health

ASJC Scopus subject areas

  • Surgery

Cite this

Variation in inpatient hospital and physician payments among patients undergoing general versus orthopedic operations. / Ejaz, Aslam; Gani, Faiz; Kim, Yuhree; Pawlik, Timothy M.

In: Surgery, Vol. 160, No. 6, 01.12.2016, p. 1657-1665.

Research output: Contribution to journalArticle

Ejaz, Aslam ; Gani, Faiz ; Kim, Yuhree ; Pawlik, Timothy M. / Variation in inpatient hospital and physician payments among patients undergoing general versus orthopedic operations. In: Surgery. 2016 ; Vol. 160, No. 6. pp. 1657-1665.
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abstract = "Background Comparative data on surgeon payments for operative procedures are not well documented. We sought to assess variations in surgeon payments after common general and orthopedic operations using a nationally representative sample of privately insured patients. Methods A total of 486,506 patients who underwent a general (appendectomy, cholecystectomy, colectomy) or orthopedic (total knee replacement, total hip replacement) operation between 2010–2012 were identified from the Truven Health MarketScan database. Results Median age was 54 years (general operation, 44 years vs orthopedic operation, 58 years; P < .001). Patients had an average Charlson Comorbidity Index of 0 (interquartile range [IQR]: 0, 1). Median duration of stay was 3 days (IQR: 2, 4) (general operation, 3 days [IQR: 1, 5] vs orthopedic operation, 3 days [IQR: 2, 3]; P < .001). Total hospital payments averaged $18,209 (IQR: $11,751, $26,598) (general operation: $12,744 [IQR: $8,402, $19,896] vs orthopedic operation: $22,386 [IQR: $16,888, $30,100]; P < .001). Median surgeon reimbursement was $1,923 (IQR: $1,146, $2,676), with orthopedic surgeon payments being on average twice as high as general surgeon payments ($2,349 vs $1,191; P < .001). Median surgeon payment varied among both general (appendectomy: $903 vs cholecystectomy: $1,125 vs colectomy: $2,209; P < .001) and orthopedic operations (total knee replacement: $2,282 vs total hip replacement: $2,392; P < .001). The presence of a postoperative complication resulted in an increase in hospital payments by 25{\%} and surgeon payments by 11{\%}. Conclusions Hospital and surgeon payments following routine general and orthopedic operations vary greatly. Patients with comorbid conditions and those who experienced a postoperative complication resulted in higher overall payments. Though significant variability existed at the surgeon level, hospital payments were responsible for the highest source of variability.",
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AB - Background Comparative data on surgeon payments for operative procedures are not well documented. We sought to assess variations in surgeon payments after common general and orthopedic operations using a nationally representative sample of privately insured patients. Methods A total of 486,506 patients who underwent a general (appendectomy, cholecystectomy, colectomy) or orthopedic (total knee replacement, total hip replacement) operation between 2010–2012 were identified from the Truven Health MarketScan database. Results Median age was 54 years (general operation, 44 years vs orthopedic operation, 58 years; P < .001). Patients had an average Charlson Comorbidity Index of 0 (interquartile range [IQR]: 0, 1). Median duration of stay was 3 days (IQR: 2, 4) (general operation, 3 days [IQR: 1, 5] vs orthopedic operation, 3 days [IQR: 2, 3]; P < .001). Total hospital payments averaged $18,209 (IQR: $11,751, $26,598) (general operation: $12,744 [IQR: $8,402, $19,896] vs orthopedic operation: $22,386 [IQR: $16,888, $30,100]; P < .001). Median surgeon reimbursement was $1,923 (IQR: $1,146, $2,676), with orthopedic surgeon payments being on average twice as high as general surgeon payments ($2,349 vs $1,191; P < .001). Median surgeon payment varied among both general (appendectomy: $903 vs cholecystectomy: $1,125 vs colectomy: $2,209; P < .001) and orthopedic operations (total knee replacement: $2,282 vs total hip replacement: $2,392; P < .001). The presence of a postoperative complication resulted in an increase in hospital payments by 25% and surgeon payments by 11%. Conclusions Hospital and surgeon payments following routine general and orthopedic operations vary greatly. Patients with comorbid conditions and those who experienced a postoperative complication resulted in higher overall payments. Though significant variability existed at the surgeon level, hospital payments were responsible for the highest source of variability.

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