Financial implications of nonoperative fracture care at an academic trauma center.

OBJECTIVE: To determine if nonoperative fracture Current Procedural Technology codes generate a significant portion of annual revenues in an academic practice. DESIGN: Retrospective review of an orthopaedic trauma practice billings during fiscal year 2008. SETTING: An urban level-1 trauma center. PATIENTS: Outpatient clinic, and all consults, to the orthopaedic trauma service in the emergency room and hospital wards staffed by an attending traumatologist. MAIN OUTCOME MEASUREMENTS: An analysis was made of relative value units (RVUs) generated by operative and nonoperative care, separating the later into clinic, consults, and closed (nonoperative) fracture treatment. RESULTS: A total of 19,815 RVUs were generated by the trauma service during the 2008 fiscal year. Emergency department and ward consults generated 2176 (11%) of RVUs, whereas outpatient clinic generated an additional 1313 (7%) of RVUs. Nonoperative (closed) fracture care generated 2725 (14%) RVUs, whereas surgical procedures were responsible for the remaining 13,490 (68%) of RVUs. In terms of overall financial reimbursement, nonoperative management, consults, and office visits generated 31% of income for the trauma service. CONCLUSIONS: Although the largest financial contribution to a busy surgical practice is operative procedures, 1 must not overlook the important impact of nonoperative fracture care and consults. In our academic center, nearly one-third of all income was generated from nonsurgical procedures. In the current medical/financial climate, 1 must be diligent in optimizing the finances of trauma care to sustain an economically viable practice. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.