A Simple Diagnosis-Related Groups-Based Reimbursement System Is Cost Ineffective for Elderly Patients With Displaced Femoral Neck Fracture Undergoing Hemiarthroplasty in Beijing.

Xi-Sheng Weng,Yuan Xu,Jia Zhang,Bao-Zhong Zhang,Hui-Ming Peng,Pu-Wo Ci

doi:10.3389/fmed.2021.733206

Abstract

Displaced femoral neck fractures (FNF) in the elderly are a major public health concern that necessitates hemiarthroplasty (HA) as the mainstay treatment option. Diagnosis-Related Groups (DRG) are a patient classification system that categorizes patients based on the resources expended on them. The first objective of this study was to evaluate if a simplified DRG-based reimbursement system in Beijing would lower total HA treatment costs for elderly patients with displaced FNF. In addition, we aimed to determine how age, gender, year of admission, length of in-hospital stay, and the Charlson index affected total treatment costs. This retrospective study included 513 patients from the Peking Union Medical College Hospital. The patients were diagnosed with unilateral displaced femoral neck fractures and had HA. Medical information was gathered, including baseline demographic and clinical data, as well as treatment costs. Patients were classified into two groups: those who spent more than the predetermined cut-off cost and those who did not. The cost did not include the use of a bipolar prosthesis. Data from the two groups were compared, and multiple regression analysis models were constructed. The median total cost of treatment was ¥49,626 ($7,316). The majority of the patients (89.7%; 460/513) were categorized as exceeding the cost cut-off. Multiple linear regression analysis revealed that total treatment cost was positively correlated with age (p < 0.01) and the duration of in-hospital stay (p < 0.01) but not with gender (p = 0.160) or the Charlson index (p = 0.548). On implementing the DRG-based reimbursement system, the overall treatment costs increased by ¥21,028 ($3,099) (p < 0.01). The implementation of simplified DRG-prospective payment systems did not result in a significant reduction in total treatment costs for elderly patients with FNF who underwent HA in Beijing. The overall cost of treatment was associated with several factors, including age, length of hospitalization, and year of admission.

Highlights

Osteoporosis is on the rise around the world, resulting in an increasing number of hip fractures, which are associated with a high rate of morbidity and death
A total of 513 patients with displaced femoral neck fractures (FNF) who met the study inclusion criteria were enrolled in the study
The current study found that simplifying the DiagnosisRelated Groups (DRG)-PPS did not significantly reduce the total cost of HA for patients with FNF

Summary

Introduction

Osteoporosis is on the rise around the world, resulting in an increasing number of hip fractures, which are associated with a high rate of morbidity and death. The costs of corrective surgeries to treat fractures put a significant burden on healthcare budgets [1]. Internal fixation and closed or open reduction are two treatment options for FNFs. Hip hemiarthroplasty (HA) and total hip arthroplasty (THA) are options (THA). Internal fixation for older individuals with displaced fractures increases the likelihood of non-union. THA, on the other hand, is considered to be a more expensive treatment. For these reasons, HA has remained the mainstay treatment option for elderly patients with these fractures in Beijing, China.

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