The Gap in Hospital and Surgeon Reimbursement for Treating Hip Fracture Patients

    In recent years, hospital charges and Medicare payments for patients with hip fractures have increased much more rapidly than charges and payments for orthopaedic surgeons, according to a new analysis from UVA Health in Charlottesville, Virginia.

    The gap in Medicare reimbursements for hospitals compared with reimbursement for surgeons has widened substantially in the last decade, even as patient outcomes have improved and the use of healthcare resources has decreased. “The results confirm our hypothesis that hospital charges and payments contribute significantly more to the increasing cost of treating a hip fracture patient than surgeon charges and payments do,” the researchers said in their paper, which was published online ahead of print by the Journal of Orthopaedic Trauma.

    To evaluate trends and variations in hospital versus surgeon charges and payments, the researchers analyzed Medicare data on more than 28,000 patients treated for hip fracture between 2005 and 2014. The analysis included 2 hip fracture sites and 3 types of procedures.

    About 25,000 patients were treated with open reduction and internal fixation (ORIF) for proximal femur fractures. For this group, hospital charges increased by 76.9% during the study period, from about $37,000 to $66,000 per patient. By comparison, surgeon charges increased by 22.2%, from about $3,100 to $3,900. There were also discrepant trends in payments: Hospital payments increased by 39% (from about $10,500 to $14,700 per patient), while surgeon payments decreased by 7.5% (from $916 to $847).

    For a better comparison of trends in hospital and surgeon reimbursement, the researchers calculated a “charge multiplier” (CM) and a “payment multiplier” (PM). Both multipliers continually increased over time: The CM for ORIF increased from 11.9 in 2005 to 17.2 in 2014. Meanwhile, the PM increased from 11.5 to 17.4. In other words, hospital payments were about 11 times higher than surgeon payments in 2005, but 17 times higher in 2014.

    Similar trends were noted for approximately 3000 patients undergoing closed reduction and percutaneous pinning of femoral neck fractures. For this procedure, the CM increased from 10.1 to 15.6, while the PM increased from 15.1 to 19.2. The trends were consistent across US regions.

    The burden of health problems for patients with hip fracture increased during the years studied, based on a standard comorbidity index. However, patient outcomes improved, including lower mortality rates and a shorter average hospital length of stay (LOS).

    “Theoretically, this decrease in LOS should decrease hospital resource utilization and consequently, hospital charges and payments,” the authors said. But instead, “[a]s LOS decreased, hospital charges and payments actually increased relative to surgeon charges and payments.”

    The study cannot explain the widening gap between hospital and surgeon reimbursements, at a time when total charges for treating a patient with hip fracture are paradoxically increasing. The authors concluded: “Identifying and rectifying the sources of increased hospital charges – rather than continually minimizing surgeon reimbursement – will be tantamount to minimizing the financial burden of hip fractures on the health care system while continuing to deliver effective and efficient patient care in the coming years.”


    Chen DQ, Quinlan ND, Browne JA, Werner BC. Increased reimbursement for surgical fixation of hip fractures: the difference between the hospital and the surgeon. J Orthop Trauma 9 March 2021. doi: 10.1097/BOT.0000000000002092. Online ahead of print.