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

Document Type : RESEARCH PAPER


1 Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA

2 Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA


Background: Relative value units (RVUs) are assigned to Current Procedural Technology (CPT) codes and give
relative economic values to the services physicians provide. This study compared the RVU reimbursements for the
surgical 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 1,437 patients of at least 65 years
of age with proximal humerus fractures between 2008 and 2016 were identified. Of those, 259 underwent RSA/TSA
(CPT code 23472), 418 underwent HA (CPT codes 23470 and 23616), and 760 underwent ORIF (CPT code 23615).
Univariate analysis compared RVU per minute, reimbursement rate, and the average annual revenue across cohorts
based on respective operative times.
Results: RSA/TSA generated a mean RVU per minute of 0.197 (SD 0.078; 95%CI [0.188, 0.207]), which was
significantly greater than the mean RVU per minute for 23470 HA (0.156; SD 0.057; 95%CI [0.148, 0.163]), 23616 HA
(0.166; SD 0.065; 95%CI [0.005, 0.156]), and ORIF (0.135; SD 0.048; 95%CI [0.132, 0.138]; p <0.001). This converted
to respective reimbursement rates of $6.97/min (SD 2.78; 95%CI [6.63, 7.31]), $5.48/min (SD 2.05; 95%CI [5.22,
5.74]), $5.83/min (SD 2.28; 95%CI [5.49, 6.16]) and $4.74/min (SD 1.69; 95%CI [4.62, 4.87]). After extrapolation,
respective average annual revenues were $580,386, $456,633, $475,077, and $395,608.
Conclusion: RSA/TSA provides significantly greater reimbursement rates compared to HA and ORIF. Orthopaedic
surgeons can use this information to optimize daily procedural cost-effectiveness in their practices.
Level of evidence: III


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  • Receive Date: 31 August 2020
  • Revise Date: 10 November 2020
  • Accept Date: 14 November 2020
  • First Publish Date: 15 November 2020