AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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AAPS 85th Annual Meeting
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Economics of Upper Extremity Replantation: National and Local Trends
Michael Chen, M.D., Deepak Narayan, M.D..
Yale University, New Haven, CT, USA.

PURPOSE: As reimbursements fall for reconstructive surgery, the number of cosmetic procedures performed has increased. The purpose of this study is to show that not only are large, teaching hospitals doing more of the reconstructive surgery, specifically upper extremity replants, they are also getting paid less to do so.
METHODS:
We looked at the Nationwide Inpatient Sample. We used SAS software to extract all patients who had undergone upper extremity replantation, examining trends in teaching status and hospital bedsize. Locally we also examined Yale's billing data.
RESULTS:
3,219 upper extremity replants were coded in the NIS, representing 16,128 replants performed in the U.S. from 1993-2002. The percent of replants performed at teaching hospitals increased over two-fold. Those performed at nonteaching hospitals declined.

Also, a larger percentage of replants were being done at large hospitals.
At Yale, the percent of the professional fee that was actually paid dropped.

CONCLUSION:
With respect to upper extremity replants, teaching hospitals are bearing the proportionally largest economic burden of managed care’s declining reimbursements for reconstructive procedures. If this replant data is representative of trends in reconstructive surgery, then this model of ever-increasing volume and diminishing reimbursements in large academic medical centers may not be sustainable.


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