Costs

Costs were defined from the healthcare insurer (payer) perspective applied from the Medicare 2015 fee schedule and include the average national surgeon reimbursement for open treatment of per-/subtrochanteric femur fracture with an intramedullary nail (Current Procedural Terminology code [CPT] 27245), prophylactic treatment of the femur (CPT 27495), initial inpatient hospital care (CPT 99222), followup office visits (CPT 99203, 99213), and hospital payment for Diagnosis-Related Group codes 480, 481, or 482 (hip and femur procedures [nonjoint] with or without a minor or major complication) (Table ​(Table2)2) [7, 8]. Facility prices were used for CPT 27245, 27495, and 99222, whereas nonfacility fees were used for CPT 99203 and 99213. Cost ranges were determined using the ratio of single-facility maximum and minimum payments to the average national payment. Skilled nursing facility (SNF) stays and the costs of surgical complications were also modeled. The average SNF stay for a hip fracture was determined from the literature with the relative length of stay for prophylactic fixation and complications assessed by surgeon experience [6, 15, 17]. It was assumed that there were no new costs 1 year after fracture or prophylaxis. Costs were discounted at 3% per year [44].

Cost tables