Purpose
To examine physician and hospital reimbursement for digit and thumb replantation compared
with revision amputation.
Methods
Using the 2009–2016 Truven Health MarketScan Research Databases, we identified patients
with a digit or thumb amputation. Following application of our inclusion and exclusion
criteria, we divided patients into replantation and revision amputation groups. We
extracted the mean physician and hospital reimbursement associated with each patient
encounter. For comparison, we examined the work Relative Value Unit (wRVU) and Medicare
Physician Fee Schedule (MPFS) for the respective procedures in addition to several
common hand surgery procedures.
Results
We identified 51,716 patients. Following application of our inclusion and exclusion
criteria, 219 replantation and 6,209 revision amputation patients were included in
our analysis. For replantation, the mean physician and hospital reimbursements ranged
from $3,938 to $7,753 and $30,683 to $56,256, respectively. For revision amputation,
the mean physician and hospital reimbursements ranged from $1,030 to $1,206 and $2,877
to $4,188, respectively. On multivariable analysis, hospitals performing replantation
earned $37,788 more per case compared with revision amputation. Using the wRVU and
MPFS data, we determined that replantation reimburses at $78/wRVU compared with higher
earnings for revision amputation ($108), carpal tunnel release ($101), cubital tunnel
release ($97), trigger finger release ($116), open reduction and internal fixation
(ORIF) distal radius fracture ($87), flexor tendon repair ($98), extensor tendon repair
($122), repair of digital nerve ($89), and ORIF articular fracture ($82), respectively.
Conclusions
Low physician reimbursement for replantation compared with less complex hand procedures
makes it difficult to recruit and retain hand surgeons for this purpose. By understanding
the wRVU and MPFS system, hand surgeons and professional societies can explore ways
to promote change in the way replantation is valued by the Centers for Medicare and
Medicaid Services (CMS) as well as by hospital administrators.
Type of study/level of evidence
Economic/Decision Analysis III.
Key words
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Article info
Publication history
Published online: April 17, 2019
Accepted:
February 26,
2019
Received:
June 24,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
