Comparing Relative Value Units among Shoulder Arthroplasty, Hemiarthroplasty, and ORIF for Proximal Humerus Fractures in the Elderly: Which is Most Worth Your Time?

Relative value units (RVUs) are assigned to Current Procedural Technology (CPT) codes and giverelative economic values to the services physicians provide. This study compared the RVU reimbursements for thesurgical options of proximal humerus fractures in the elderly, which include arthroplasty (reverse [RSA] and total [TSA]),hemiarthroplasty (HA), and open reduction and internal fixation (ORIF). Using the National Surgical Quality Improvement Program, a total of 1,437 patients of at least 65 yearsof age with proximal humerus fractures between 2008 and 2016 were identified. Of those, 259 underwent RSA/TSA(CPT code 23472), 418 underwent HA (CPT codes 23470 and 23616), and 760 underwent ORIF (CPT code 23615).Univariate analysis compared RVU per minute, reimbursement rate, and the average annual revenue across cohortsbased on respective operative times. RSA/TSA generated a mean RVU per minute of 0.197 (SD 0.078; 95%CI [0.188, 0.207]), which wassignificantly greater than the mean RVU per minute for 23470 HA (0.156; SD 0.057; 95%CI [0.148, 0.163]), 23616 HA(0.166; SD 0.065; 95%CI [0.005, 0.156]), and ORIF (0.135; SD 0.048; 95%CI [0.132, 0.138]; p <0.001). This convertedto respective reimbursement rates of $6.97/min (SD 2.78; 95%CI [6.63, 7.31]), $5.48/min (SD 2.05; 95%CI [5.22,5.74]), $5.83/min (SD 2.28; 95%CI [5.49, 6.16]) and $4.74/min (SD 1.69; 95%CI [4.62, 4.87]). After extrapolation,respective average annual revenues were $580,386, $456,633, $475,077, and $395,608. RSA/TSA provides significantly greater reimbursement rates compared to HA and ORIF. Orthopaedicsurgeons can use this information to optimize daily procedural cost-effectiveness in their practices.Level of evidence: III