Peter B. Derman

Risk Factors, Causes, and the Economic Implications of Unplanned Readmissions Following Total Hip Arthroplasty

In order to identify risk factors for readmissions following total hip arthroplasty (THA) and the causes and financial implications of such readmissions, we analyzed clinical and administrative data on 1583 consecutive primary THAs performed at a single institution. The 30-day readmission rate was 6.51%. Increased age, length of stay, and body mass index were associated with significantly higher readmission rates. The most common re-admitting diagnoses were deep infection, pain, and hematoma. Average profit was lower for episodes of care with readmissions (

The Role of Overweight and Obesity in Relation to the More Rapid Growth of Total Knee Arthroplasty Volume Compared with Total Hip Arthroplasty Volume

1548 vs.

Orthopaedics and the Physician Payments Sunshine Act: An Examination of Payments to U.s. Orthopaedic Surgeons in the Open Payments Database

2872, P=0.028). If Medicare stops reimbursing for THA readmissions, the institution under review would sustain an average net loss of

Spinning-induced Rhabdomyolysis and the Risk of Compartment Syndrome and Acute Kidney Injury Two Cases and a Review of the Literature

11,494 for episodes of care with readmissions and would need to maintain readmission rates below 23.6% in order to remain profitable.

Are There Identifiable Risk Factors and Causes Associated with Unplanned Readmissions Following Total Knee Arthroplasty

BACKGROUND The volume of primary joint replacements performed in the United States increased rapidly over the past twenty years, but the growth rate of total knee arthroplasties exceeded that of total hip arthroplasties. The aim of this study was to identify the key contributing factors behind this differential growth rate. METHODS We compiled longitudinal data on total hip arthroplasty and total knee arthroplasty volume, length of hospital stay, and in-hospital mortality from the Nationwide Inpatient Sample; we calculated reimbursement using information available in the Federal Register and Centers for Medicare & Medicaid Services databases; we determined trends in body mass index from Behavioral Risk Factor Surveillance System findings; and we estimated the size of the surgical workforce based on membership data from the American Academy of Orthopaedic Surgeons. These sources each contained at least ten years of data, ending in 2009. Data sources were analyzed and were compared to identify supply-side and demand-side factors contributing to the more rapid growth observed in total knee arthroplasty. RESULTS Of the factors examined, body mass index played the most substantial role in increasing demand for total knee arthroplasty above that of total hip arthroplasty, with younger individuals affected to a greater degree. More rapid growth in utilization of total knee arthroplasty over total hip arthroplasty in individuals with a body mass index of ≥25 kg/m2 was responsible for 95% of the differential increase in total knee arthroplasty over total hip arthroplasty volumes. Hospital and physician reimbursement, length of stay, and in-hospital mortality did not improve more for total knee arthroplasty than total hip arthroplasty. The surgical community responded to additional demand primarily by increasing per-physician output. CONCLUSIONS Growth in total knee arthroplasty volume has far outpaced that of total hip arthroplasty among those with a body mass index of ≥25 kg/m2 but not for those with a body mass index of <25 kg/m2. The magnitude of this effect will continue to expand if the proportion of Americans with a body mass index of ≥25 kg/m2 continues to increase. Changes in hospital and physician reimbursement, length of stay, and in-hospital mortality did not contribute to this differential growth rate.

Paying Surgeons Less Has Cost More

BACKGROUND The U.S. Centers for Medicare & Medicaid Services (CMS) recently released the Open Payments database (OPD) detailing payments from industry to physicians and teaching hospitals. We seek here to provide an overview of the data with a focus on the orthopaedic community. METHODS We analyzed payments in the OPD from August 1 to December 31, 2013. The OPD consists of three individual databases: General Payments, Research Payments, and Ownership. Physician identification number, physician specialty, payment type, and payment value were collected. Physicians assigned to multiple specialties were excluded. Comparisons were made between orthopaedic surgeons and the remainder of the top fifteen specialties by payment value. RESULTS In all, 2,697,015 payments with physicians were recorded; 491,223 of these payments (18.2%) were made to physicians with multiple listed specialties and were excluded. Excluding these potentially misattributed payments did not have a significant impact on the trends identified, and

Saline-Coupled Bipolar Sealing in Simultaneous Bilateral Total Knee Arthroplasty

394.5 million in payments remained. Orthopaedic surgeons represented 3.4% of payments but 25.6% of value, and 13,347 orthopaedic surgeons (68.9% of all active orthopaedic surgeons) were listed in the OPD. Payments over

Dramatic Increase in Total Knee Replacement Utilization Rates Cannot Be Fully Explained by a Disproportionate Increase Among Younger Patients

10,000 represented only 1.6% of payments to orthopaedic surgeons but 75.5% of value. The majority of these payments (56.1%) were royalties. The median payment value for orthopaedic surgeons listed in the OPD was

Outpatient Anterior Cervical Discectomy and Fusion is Associated With Fewer Short-term Complications in One- and Two-level Cases: A Propensity-adjusted Analysis

38.11, with two payments per surgeon; the median aggregated value was

Osteotomies in the Cervical Spine

132.56 per surgeon. Orthopaedic surgeons listed in the OPD were more likely to receive payments for travel compared with all other specialties (p < 0.001) and more likely to receive payments for royalties compared with all other specialties (p < 0.001) except neurological surgery. CONCLUSIONS Financial interactions between orthopaedic surgeons and industry are highly prevalent. A small subset of orthopaedic surgeons received large royalties, which accounted for a majority of the transactional value provided by industry. Orthopaedic surgeons were the recipients of more payments for travel and for royalties than all other specialties except neurological surgery; however, the median value of these and other payments was similar to that for other specialties.