Hospital and Regional-Level Factors Associated With Negotiated Payer Rates for Hip Fracture Fixation: A Multistate Analysis.

OBJECTIVES: Hip fractures represent a significant cost burden internationally, offering an area for improving value-based care. The objective of this study was to evaluate associations between hospital/regional-level characteristics and negotiated payer rates for one type of hip fracture (ie, proximal femoral fracture) fixation in the United States. METHODS: This was a retrospective study using payer data from the Turquoise Health database using Current Procedural Terminology code 27245. Medicaid expansion status (ie, a state's decision to expand public health insurance to more low-income adults), certificate-of-need (CoN) regulations (ie, rules that govern healthcare facility construction and expansion), hospital type (acute care vs critical access), and ownership model (government, nonprofit, proprietary, or physician-owned) were obtained from publicly available sources. Multilevel generalized linear mixed-effects models assessed associations, with results reported as the geometric mean ratio with 95% CI. RESULTS: A total of 66 483 rates across 968 hospitals and 41 states were analyzed. Of the 968 hospitals, a majority were acute care hospitals (n = 747, 77.2%) and nonprofit (n = 610, 63.0%). CoN status was associated with higher rates among dual insurance class (geometric mean ratio: 8.77; 95% CI 4.59-16.76; P < .001). Nonprofit hospitals charged higher rates on average compared with proprietary hospitals across multiple payer classes. CONCLUSIONS: CoN status and hospital ownership type are associated with variations in femoral fracture fixation payer rates. Policy makers can consider implementing standardized pricing models or increasing transparency in negotiations to mitigate cost variations for femoral fracture care.

Duke Scholars

Author Malcolm R DeBaun Orthopaedic Surgery

Author Christian Pean Orthopaedic Surgery

Author Cynthia Lea Green Biostatistics & Bioinformatics, Division of Biostatistics