Purpose
The purpose of this study was to determine the cost of the episode of care for primary
rotator cuff repair (RCR) from day of surgery to 90 days postoperatively using the
time-driven activity-based costing (TDABC) method. The secondary purpose of this study
was to identify the main drivers of cost for both phases of care.
Methods
This retrospective case series study used the TDABC method to determine the bundled
cost of care for an RCR. First, a process map of the RCR episode of care was constructed
in order to determine drivers of fixed (i.e., rent, power), direct variable (i.e., healthcare
personnel), and indirect costs (i.e., marketing, building maintenance). The study
was performed at a Midwestern tertiary care medical system, and patients were included
in the study if they underwent an RCR from January 2018 to January 2019 with at least
90 days of postoperative follow-up. In this article, all costs were included, but
we did not account for fees to provider and professional groups.
Results
The TDABC method calculated a cost of $10,569 for a bundled RCR, with 76% arising
from the operative phase and 24% from the postoperative phase. The main driver of
cost within the operative phase was the direct fixed costs, which accounted for 35%
of the cost in this phase, and the largest contributor to cost within this category
was the cost of implants, which accounted for 55%. In the postoperative phase of care,
physical therapy visits were the greatest contributor to cost at 59%.
Conclusion
In a bundled cost of care for RCR, the largest cost driver occurs on the day of surgery
for direct fixed costs, in particular, the implant. Physical therapy represents over
half of the costs of the episode of care. Better understanding the specific cost of
care for RCR will facilitate optimization with appropriately designed payment models
and policies that safeguard the interests of the patient, physician, and payer.
Level of Evidence
IV, therapeutic case series.
Key Words
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References
- National health expenditure projections, 2016-25: Price increases, aging push sector to 20 percent of economy.Health Aff (Millwood). 2017; 36: 553-563https://doi.org/10.1377/hlthaff.2016.1627
- What is value in health care?.N Engl J Med. 2010; 363: 2477-2481https://doi.org/10.1056/NEJMp1011024
- National trends in rotator cuff repair.J Bone Joint Surg Am. 2012; 94: 227-233https://doi.org/10.2106/JBJS.J.00739
- Time-driven activity-based costing.Harv Bus Rev. 2004; 82 (150): 131-138
- Time-driven activity-based costing more accurately reflects costs in arthroplasty surgery.Clin Orthop Relat Res. 2016; 474: 8-15https://doi.org/10.1007/s11999-015-4214-0
- Time-driven activity-based costing to identify patients incurring high inpatient cost for total shoulder arthroplasty.J Bone Joint Surg. 2018; 100: 2050-2056https://doi.org/10.2106/JBJS.18.00281
- The cost of joint replacement: comparing two approaches to evaluating costs of total hip and knee arthroplasty.J Bone Joint Surg. 2018; 100: 326-333https://doi.org/10.2106/JBJS.17.00161
- Endoscopic versus open carpal tunnel release: A detailed analysis using time-driven activity-based costing at an academic medical center.J Hand Surg. 2019; 44: 62.e1-62.e9https://doi.org/10.1016/j.jhsa.2018.04.023
- Assessment of health care cost for complex surgical patients: Review of cost, re-imbursement and revenue involved in pancreatic surgery at a high-volume academic medical centre.HPB. 2015; 17: 311-317https://doi.org/10.1111/hpb.12349
- Understanding time-driven activity-based costing.Clin Spine Surg. 2016; 29: 62-65https://doi.org/10.1097/BSD.0000000000000360
- “Salary Average.” Glassdoor.
- Time-driven activity-based costing in fracture care: Is this a more accurate way to prepare for alternative payment models?.J Orthop Trauma. 2018; 32: 344-348https://doi.org/10.1097/BOT.0000000000001185
- Determining the true cost to deliver total hip and knee arthroplasty over the full cycle of care: Preparing for bundling and reference-based pricing.J Arthroplasty. 2016; 31: 1-6https://doi.org/10.1016/j.arth.2015.07.013
- Time-driven activity-based costing provides a lower and more accurate assessment of costs in the field of orthopaedic surgery compared with traditional accounting methods.Arthroscopy. 2021; 37: 1620-1627https://doi.org/10.1016/j.arthro.2020.11.028
- The primary cost drivers of arthroscopic rotator cuff repair surgery: A cost-minimization analysis of 40,618 cases.J Shoulder Elbow Surg. 2019; 28: 1977-1982https://doi.org/10.1016/j.jse.2019.03.004
- Cost of arthroscopic rotator cuff repairs is primarily driven by procedure-level factors: A single-institution analysis of an ambulatory surgery center.Arthroscopy. 2021; 37: 1075-1083https://doi.org/10.1016/j.arthro.2020.11.033
- Editorial Commentary: Stagnant surgeon reimbursement since 2005 does not reflect the current complexity of arthroscopic rotator cuff repair in 2020.Arthroscopy. 2020; 36: 2362-2363https://doi.org/10.1016/j.arthro.2020.06.021
- The cost of outpatient arthroscopic rotator cuff repairs: Hospital reimbursement is on the rise while surgeon payments remain unchanged.Arthroscopy. 2020; 36: 2354-2361https://doi.org/10.1016/j.arthro.2020.03.038
- Editorial Commentary: A rigged game—Surgeon reimbursement under the resource-based relative value scale, current procedural terminology, and the Affordable Care Act.Arthroscopy. 2020; 36: 2364-2366https://doi.org/10.1016/j.arthro.2020.05.010
- Lessons learned from bundled payment programs.Instr Course Lect. 2018; 67: 629-644
- Cost analysis and bundled care of hip and knee replacement.J Surg Orthop Adv. 2019; 28: 241-249
- Bundled payment arrangements: Keys to success.J Am Acad Orthop Surg. 2018; 26: 817-822https://doi.org/10.5435/JAAOS-D-17-00022
- Predicting costs exceeding bundled payment targets for total joint arthroplasty.J Arthroplasty. 2019; 34: 412-417https://doi.org/10.1016/j.arth.2018.11.012
- A systematic review of cost-effective treatment of postoperative rotator cuff repairs.J Shoulder Elbow Surg. 2017; 26: 915-922https://doi.org/10.1016/j.jse.2017.02.009
- Time-driven activity-based costing for anterior cruciate ligament reconstruction: A comparison to traditional accounting methods.Arthrosc Sports Med Rehabil. 2021; 3: e39-e45https://doi.org/10.1016/j.asmr.2020.08.006
- 2021 Review of Physician and Advanced Practitioner Recruiting Incentives.https://www.merritthawkins.com/uploadedFiles/physician-advanced-practitioner-incentive-review-2021.pdfDate accessed: November 20, 2021
Article info
Publication history
Published online: February 18, 2022
Accepted:
February 6,
2022
Received:
October 9,
2021
Footnotes
See commentary on page 2378
Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America