Electronic Letters to:

Hip: C. W. McBryde, K. Dehne, A. M. Pearson, R. B. C. Treacy, and P. B. Pynsent One- or two-stage bilateral metal-on-metal hip resurfacing arthroplasty J Bone Joint Surg Br 2007; 89-B: 1144-1148 [Abstract] [Full text] [PDF]

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The real financial burden of one-stage hip resurfacing

Simon S Jameson, Mike R Reed   (15 January 2008)

The real financial burden of one-stage hip resurfacing 15 January 2008
Simon S Jameson, Orthopaedic Registrar NHS Greater Glasgow and Clyde, Mike R Reed Send letter to journal: Re: The real financial burden of one-stage hip resurfacing simonjameson{at}doctors.org.uk Simon S Jameson, et al.	Sir, We read this article with interest. This study compares the clinical and financial implications of two approaches to bilateral hip resurfacing. Funding of secondary care in the National Health Service (NHS) is described. Hospital trusts are reimbursed for each patient at nationally agreed tariffs.1 These costs are met by Primary Care Trusts (PCT). Using 2006 tariffs, a trust was reimbursed £6338 for a one-stage procedure and £9380 (combined tariff for both sides) for a two-stage procedure.2 Total reimbursement for each patient was calculated to analyse financial benefit to the trust. They conclude that a one-stage procedure has cost benefits over a two-stage procedure. However, these ‘reimbursement’ costs merely represent the costs recovered from the PCT and do not correspond to the actual cost to the trust of performing these operations. In addition, a market force factor (MFF) is applied to the tariff.1 At the authors’ unit this factor is 1.126, increasing the tariff to £7137 for a one-stage procedure. List price for a resurfacing implant is £2500.1 Cost per day for a hospital bed is estimated at £200.3 A one-stage procedure (mean length of stay is 11 days) would therefore cost the hospital £7200. Surgeon fees, cement, theatre resources and rehabilitation will add additional costs. As reimbursement is lower than the actual costs, the hospital would suffer a loss. For a two-stage procedure, with reimbursement at £10562 (including MFF), the costs (including a longer stay) would be covered. The reduction of costs described in performing a one-stage procedure is actually of financial benefit to the PCT, at the expense of the trust. It is helpful to have this data available for resurfacing patients, and surgeons may be willing to accept the higher systemic risks of one-stage procedures. However, surgeons should not be under the illusion that they are saving their trusts money by performing one-stage surgery. They are simply adding to the financial burden. S.S. Jameson, Orthopaedic Registrar, M.R. Reed, NHS Greater Glasgow and Clyde, Glasgow, UK. 1. Jameson S, Reed MR. Payment by results and coding practice in the National Health Service: the importance for orthopaedic surgeons. J Bone Joint Surg [Br] 2007;89-B:1427-30. 2. Department of Health (DoH). National tariff 2006/07. Payment by Results. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4127649 (last accessed 15/01/08). 3. Department of Health (DoH). Reduce wasted bed days, improve patient care and save money. http://www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4132360 (last accessed 11/01/08).