CORR Insights(®): Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis.

Abstract

H ip fractures are common, and treating patients with them is challenging because the patients often are older and medically complicated. New payment models initiated by the Patient Protection and Affordable Care Act (which encourages bundled payments and the formation of accountable care organizations) focuses on high-cost procedures [2, 7]. The systems used to provide care for patients with diverse diagnoses, including hip fracture, also vary; this would appear to offer a meaningful opportunity to improve both outcomes and costs [5]. With total treatment costs estimated at more than USD 12 billion, hip fracture care in the United States certainly represents a worthwhile topic for further evaluation. Swart and colleagues performed an economic analysis to determine the cost-effectiveness of a comanaged model of care for geriatric patients with hip fracture. The prevalent ‘‘traditional’’ model of hip fracture care in the United States is one in which the medical physician provides preoperative clearance with variable postoperative followup care for the patient with a hip fracture on the orthopaedic surgical service [5, 9]. A small percentage of hospitals have adopted an organized medical comanagement model to improve both patient reported outcomes and process measures for patients with a hip fracture. Although the topic has been reasonably well-studied, most reports to this point involve retrospective analyses that may be subject to various types of bias [1–4]. While some studies have looked at the economics of these models, and although these reports generally suggest the models are cost-effective, these analyses only represent the study of program performance at individual hospitals [2, 7, 8]. As such, the value of the comanaged hip fracture programs remains controversial. This CORR Insights is a commentary on the article ‘‘Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis’’ by Swart and colleagues available at: DOI: 10.1007/s11999-015-4494-4. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154494-4. S. L. Kates MD (&) Department of Orthopaedics, University of Rochester, 601 Elmwood Ave., Box 665, Rochester, NY 14620, USA e-mail: stephen_kates@urmc.rochester.edu CORR Insights Published online: 1 September 2015 The Association of Bone and Joint Surgeons1 2015