Study: Hospitals lose thousands of dollars in treating open tibial fractures

Investigators found California hospitals lost more than $100,000 per case in treating a subgroup of just 8% of all tibia fracture patients.

WASHINGTON - Hospitals lose an estimated $30,000 on every patient treated for tibial fractures, according to a study of California Medicaid claims data.

"I think it is powerful evidence that hospitals lose big money on tibial shaft fractures, at least within the California Medicaid (Medi-Cal) population ... . If you take just this single code ... California hospitals lost a total of $7.4 million," said Alan L. Jones, MD, an associate professor of orthopedic surgery at the University of Texas Southwestern Medical Center, Dallas, and lead author of the study.

"This economic burden, which is substantial, can be reduced with our continued efforts to reduce complications and reduce secondary interventions. But probably ... [this] requires a further re-examination of our reimbursement policy," he continued. Jones and colleagues at several institutions in the United States performed a health claims analysis among a population of adult patients who received care between Jan. 1, 2000 and Dec. 31, 2001. The study included actual inpatient costs documented by Medi-Cal CPT code 27759 among a typical trauma population of 246 patients.

Distal tibial intraarticular fracture with a spiral extension to the diaphysis.

SOURCE: ORTHOPEDICS 2004; 27:1155.

To estimate costs, the researchers used the Medicare cost-to-charge ratio. They then applied the Medicare Medical Care Component of the Consumer Price Index to adjust the results to 2004 dollar equivalents.

Jones presented the results here at the American Academy of Orthopedic Surgeons meeting.

"We tried to capture reimbursement in terms of costs for a patient for their initial fracture treatment ... only collecting inpatient data," he said.

The researchers found that hospitals lost more than $100,000 per case in about 8% of cases, "more frequently than they made even a dollar profit," Jones said.

On average, tibial fractures cost hospitals $49,358 per case, but they received an average of $19,097 or less in reimbursement. This results in a mean loss of $30,261 per tibia fracture case, according to the study.

"If you look at the distribution ... the majority of patients [resulted in a loss for hospitals of] between $0 and $20,000. Half the patients were in that area," Jones said.

For more information:

Jones AL, Ackerman SJ, Knight T, et. al. Costs versus reimbursement for treatment of open tibial fracture in a California Medicaid population. #350. Presented at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting. Feb. 23-27, 2005. Washington.