Financial Impact of the Surgical Treatment of Infection on the Practice of Orthopedic Trauma

Abstract

Objectives: The treatment of bone, muscle, and joint infections has been under the purview of orthopedic surgeons for years. As care has become more specialized, orthopedic surgeons are offloading infection cases to services such as general surgery or podiatry. Orthopedics as a field has already yielded portions of spine to neurosurgery, recovery to physiatrists, and foot and ankle to podiatry. The purpose of this study was to report the financial impact of infection treatment on our group practice at a busy community Level II trauma center.
 Design: Retrospective Economic Review
 Setting: Level II Trauma Center
 Patients/Participants: All patients receiving orthopedic surgical intervention at our facility from January 1, 2018 to December 31, 2018.
 Intervention: Surgical treatment of bone, muscle and joint infections.
 Main Outcome Measurements: Surgical Volume, Relative Value Units, Physician Charges, Physician Collections and Payer Mix
 Results: The surgical treatment of infections including irrigation and debridement, wound closure and amputations amounted to 908 out of 3700 total cases. This included 11,405 total RVUs, 5,771 work RVUs, $2,056,677 in charges and $407,479 in collections over the 2018 calendar year. This was 16.8% of total RVUs, 19% of all charges, and 15% of collections for the orthopedic trauma service. The payer mix for these patients was less favorable with a collection rate of 20% compared to a 25% average for all surgical cases.
 Conclusions: The treatment of orthopedic infections represents a large proportion of surgical volume for orthopedic surgeons covering hospital call. Relinquishing control of these patients will result in significant financial loss as well as a decrease in our ability to control the episode of care and patient access in the changing healthcare environment.
 Level of Evidence: Therapeutic Level III