Abstract
Purpose
Residents have limited education regarding the cost of orthopaedic interventions. Orthopaedic residents’ knowledge was surveyed in three scenarios involving an intertrochanteric femur fracture: 1) uncomplicated course with 2-day hospital stay; 2) complicated course necessitating ICU admission; and 3) readmission for pulmonary embolism management.
Methods
From 2018 to 2020, 69 orthopaedic surgery residents were surveyed. Respondents estimated hospital charges and collections; professional charges and collections; implant cost; and level of knowledge depending on the scenario.
Results
Most residents (83.6%) reported feeling “not knowledgeable”. Respondents reporting “somewhat knowledgeable” did not perform better than those who reported “not knowledgeable”. In the uncomplicated scenario, residents underestimated hospital charges and collections (p < 0.01; p = 0.87), and overestimated hospital charges and collections and professional collections (all p < 0.01) with an average percent error of 57.2%. Most residents (88.4%) were aware the sliding hip screw construct costs less than a cephalomedullary nail. In the complex scenario, while residents underestimated the hospital charges (p < 0.01), the estimated collections were closer to the actual figure (p = 0.16). In the third scenario, residents overestimated the charges and collections (p = 0.04; p = 0.04).
Conclusions
Orthopaedic surgery residents receive little education regarding healthcare economics and feel unknowledgeable therefore a role for formal economic education during orthopaedic residency may exist.
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Appendix 1
Appendix 1
Survey: estimates of charges and cost for orthopaedic procedures
Please give your best estimate in US dollars for each of the following.
All answers will be reported anonymously.
Scenario 1
A 78-year-old active female has a fall from stand, sustaining a two part entered intertrochateric fracture. She was admitted to the hospital, undergoes medical optimization, and has fixation the following day with a trochanteric fixation nail. She is discharged to a skilled facility on POD#2. Assuming Medicare coverage, what are your estimates for each of the following for this episode of care:
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1.
Total hospital charges (facility only, no professional charges) ________
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2.
Total hospital collections (amount of payment by Medicare) ________
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3.
Orthopedic surgical charges ________ collections ________
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4.
Total orthopedic professional charges ______ collections ________
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5.
Costs for trochanteric fixation nail (including all related implants). ________
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6.
Costs for dynamic hip screw (including all related implants) ________
Scenario 2
Now consider if the patient was less healthy on arrival, requiring additional cardiology clearance, surgery on hospital day 2, postoperative stay in ICU two days, total hospital stay seven days, followed by discharge to skilled facility.
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1.
Total hospital charges (facility only, no professional charges) ________
-
2.
Total hospital collections (amount of payment by Medicare). ________
Scenario 3
Now consider the patient is re-admitted on post op day 12 with DVT. She has duplex ultrasound for diagnosis, has asked protocol, get slogan ACS with bridge to Coumadin. She is discharged back to the facility on hospital day three.
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1.
Total hospital charges (facility only, no professional charges) ________
-
2.
Total hospital collections (amount of payment by Medicare) ________
Do you consider yourself knowledgeable about health care costs?
YES NO SOMEWHAT
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Sinkler, M.A., Flanagan, C.D., Joseph, N.M. et al. Orthopaedic surgery residents report little subjective or objective familiarity with healthcare costs. Eur J Orthop Surg Traumatol 33, 3475–3481 (2023). https://doi.org/10.1007/s00590-023-03545-7
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DOI: https://doi.org/10.1007/s00590-023-03545-7