Economics of Upper Extremity Replantation: National and Local Trends

Background: Reimbursements have fallen for reconstructive surgery. The purpose of this study was to show that not only are large teaching hospitals performing more of the reconstructive surgery procedures, specifically upper extremity replantation, they are also getting paid less to do so. Methods: The authors examined trends in reimbursement, teaching status, and hospital size in both a national and a local database of patients who had undergone upper extremity replantation. Specifically, they used the 1993 to 2002 Nationwide Inpatient Sample as well as the local replant database from the past 5 years at Yale New Haven Hospital. Results: A total of 3219 upper extremity replantations were coded in the Nationwide Inpatient Sample, representing 16,128 replantations performed in the United States from 1993 to 2002. The percentage of replantations performed at teaching hospitals increased over two-fold (44 percent versus 89 percent). Those performed at nonteaching hospitals declined (56 percent versus 11 percent). Also, a larger percentage of replantations were being performed at large hospitals (64 percent versus 82 percent). At Yale New Haven Hospital, the percentage of the professional fee that was actually paid dropped (100 percent in 2000 versus 32 percent in 2005). Conclusions: With respect to upper extremity replantation, teaching hospitals are bearing the proportionally largest economic burden of managed care's declining reimbursements for reconstructive procedures. The authors believe that these replantation data are representative of trends in reconstructive surgery, and that the model of ever-increasing volume and diminishing reimbursements in large academic medical centers may not be sustainable. (Plast. Reconstr. Surg. 124: 2003, 2009.)