Comparing Relative Value Units among Shoulder Arthroplasty, Hemiarthroplasty, and ORIF for Proximal Humerus Fractures in the Elderly: Which is Most Worth Your Time?

Background: Relative value units (RVUs) are assigned to Current Procedural Technology (CPT) codes and giverelative economic values to the services physicians provide. This study compared the RVU reimbursements for thesurgical options of proximal humerus fractures in the elderly, which include arthroplasty (reverse [RSA] and total [TSA]),hemiarthroplasty (HA), and open reduction and internal fixation (ORIF).Methods: Using the National Surgical Quality Improvement Program, a total of ۱,۴۳۷ patients of at least ۶۵ yearsof age with proximal humerus fractures between ۲۰۰۸ and ۲۰۱۶ were identified. Of those, ۲۵۹ underwent RSA/TSA(CPT code ۲۳۴۷۲), ۴۱۸ underwent HA (CPT codes ۲۳۴۷۰ and ۲۳۶۱۶), and ۷۶۰ underwent ORIF (CPT code ۲۳۶۱۵).Univariate analysis compared RVU per minute, reimbursement rate, and the average annual revenue across cohortsbased on respective operative times.Results: RSA/TSA generated a mean RVU per minute of ۰.۱۹۷ (SD ۰.۰۷۸; ۹۵%CI [۰.۱۸۸, ۰.۲۰۷]), which wassignificantly greater than the mean RVU per minute for ۲۳۴۷۰ HA (۰.۱۵۶; SD ۰.۰۵۷; ۹۵%CI [۰.۱۴۸, ۰.۱۶۳]), ۲۳۶۱۶ HA(۰.۱۶۶; SD ۰.۰۶۵; ۹۵%CI [۰.۰۰۵, ۰.۱۵۶]), and ORIF (۰.۱۳۵; SD ۰.۰۴۸; ۹۵%CI [۰.۱۳۲, ۰.۱۳۸]; p <۰.۰۰۱). This convertedto respective reimbursement rates of ۶.۹۷/min (SD ۲.۷۸; ۹۵%CI [۶.۶۳, ۷.۳۱]), ۵.۴۸/min (SD ۲.۰۵; ۹۵%CI [۵.۲۲,۵.۷۴]), ۵.۸۳/min (SD ۲.۲۸; ۹۵%CI [۵.۴۹, ۶.۱۶]) and ۴.۷۴/min (SD ۱.۶۹; ۹۵%CI [۴.۶۲, ۴.۸۷]). After extrapolation,respective average annual revenues were ۵۸۰,۳۸۶, ۴۵۶,۶۳۳, ۴۷۵,۰۷۷, and ۳۹۵,۶۰۸.Conclusion: RSA/TSA provides significantly greater reimbursement rates compared to HA and ORIF. Orthopaedicsurgeons can use this information to optimize daily procedural cost-effectiveness in their practices.Level of evidence: III

Keywords:

geriatric population , humeral fracture , relative value analysis , surgical management