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

Abstract

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. 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. Median age was 54years (general operation, 44years vs orthopedic operation, 58years; P<.001). Patients had an average Charlson Comorbidity Index of 0 (interquartile range [IQR]: 0, 1). Median duration of stay was 3days (IQR: 2, 4) (general operation, 3days [IQR: 1, 5] vs orthopedic operation, 3days [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%. 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.