Abstract
Introduction
Studies are being done comparing 1-stage vs. 2-stage protocols for PJI. 1-stage protocols take an extended period of time requiring 2 separate preps and sets of instruments in order to ensure optimal sterility. While intraoperative service time is one part of the reimbursement algorithm, reimbursement has lagged behind for single stage treatment. If 1-stage results are acceptable, but not reimbursed appropriately, surgeons may be discouraged from managing PJI in a 1-stage fashion. We ask, “What is the reimbursement and intraoperative service time for 1-stage procedures compared to primary surgery?”
Methods
Relative Value Unit's (RVU's), reimbursement and operative time for 50 PJI procedures were reviewed and compared to 250 primary (1°) THA and 250 primary (1°) TKA by four surgeons. Coding was done per AAOS guidelines.
Results
Average work RVU's for 1-stage knees were 19.79 RVU's/hr. vs 23.47 for 1° TKA. Average reimbursement for a 1-stage knee was $2,597.08, with an average intraoperative service time of 259 minutes ($601.60/hr.). Average reimbursement for a 1° TKA was $2,435.00, with an average service time of 100 minutes ($1,461/ hr.).
Average work RVU's for a 1-stage hip were 19.57/hr. vs 25.59 for a 1° THA. Average reimbursement for a 1-stage hip was $2,826.17, with an average intraoperative service time of 311 minutes ($545.24/ hr.). The average reimbursement for a 1° total hip was $2,754.71 with an average service time of 104 minutes ($1,589.26/ hr.).
Conclusion
While RVUs/hr are similar between primaries and 1-stage procedures, 1-stage procedures for PJI are reimbursed at approximately 1/3 the hourly rate of a primary procedure. This may discourage surgeons from selecting this treatment alternative if studies confirm efficacy. Payers should be encouraged to reimburse physicians commensurate with the intraoperative service time needed to perform a 1-stage procedure as adoption will decrease morbidity and save the healthcare system financially.
