Today's News

Saturday, February 15, 1997

Specialists' charges lower than community hospital's

Treatment for a child's injury or condition may cost more at a community hospital than at a children's hospital, a study presented Friday in scientific paper 232 shows.

Researchers in Utah compared the hospital charges of community hospitals with those of a pediatric specialist hospital for treatment of the same injury/condition. They examined data on 397 children treated at 24 hospitals between 1992 and 1994 for femoral shaft fractures or slipped capital femoral epiphysis (SCFE).

"The hospital charges and the length of stay were significantly lower if the child was treated at the children's hospital," said co-author John T. Smith, MD, associate professor of orthopaedic surgery, department of orthopaedics, University of Utah, Salt Lake City.

"In the current climate of health care reform, there is a perception that overspecialization is responsible for increased medical costs," Dr. Smith said. However, compared to community hospitals, the average hospital charges were less ($4,943 vs. $9,031) and length of stay was shorter (2.81 days vs. 8.91 days) when the femoral shaft fracture was treated at the children's hospital by pediatric orthopaedic subspecialists.

Dr. Smith noted that none of the doctors at the community hospitals have subspecialty training in pediatric orthopaedics.

For femoral shaft fractures, the children's hospital saw 195 children (average age: 6.3 years); community hospitals saw 139 youths (average age: 8.6 years).

Among SCFE children (average age: 12.7 years) in this study, the average hospital charges also were less at the children's hospital ($2,824 vs. $3,544) and the length of stay was shorter (1.13 days vs. 1.64 days).

According to Dr. Smith, few studies have analyzed the value of surgical specialization in relation to the cost of care.

The judicious use of immediate-fit spica casting or operative stabilization of fractures, followed by early discharge and treatment on an outpatient basis resulted in a significant reduction in length of stay and therefore hospital charges at the children's hospital, Dr. Smith said. They treated 97 children with immediate-fit spica casting. Thirty-nine youths had operative fixation, including intramedullary nailing, plate fixation or external fixation. Prolonged skeletal or skin traction was never the definitive form of treatment the youths.

Dr. Smith said, "At the community hospitals, patients were more often treated with prolonged inpatient traction followed by spica casting." Here, 63 children received immediate-fit spica casting and 89 had operative fixation of the fracture. Forty-two youngsters were treated with prolonged traction, followed by spica casting. One child was treated by splinting alone.

Medical records for 55 (28, children's hospital; 27, community hospital) of the 63 patients treated for SCFE were available to analyze the method of treatment. Children's hospital patients were more likely (25 of 28) to have a percutaneous pinning with a single cannulated screw, Dr. Smith said. Only three children have been readmitted for screw removal.

At the community hospitals, 18 of 22 patients had an open pinning with multiple screws, necessitating greater length of stay and higher charges. Eight patients were readmitted for screw removal.

Dr. Smith noted that there is an increasing trend to direct the more routine pediatric surgical care away from children's hospitals into the community hospital setting based on the premise that it would produce significant cost savings to a given health plan.

"These data suggest that hospital utilization and cost were significantly decreased if the care was provided by pediatric orthopaedic subspecialists in a children's hospital," he said. "Directing care to surgical subspecialists best trained to manage a given problem will result in a significant efficiency of care and cost savings."

"The highest quality of care and therefore the most cost-effective care is provided by the best-qualified specialist prepared to manage a given problem," Dr. Smith said.

Co-authors of the study, with Dr. Smith, are: Christopher Price, MD, resident in orthopaedic surgery, department of orthopaedic surgery, Indiana University Medical Center, Indianapolis, Ind.; Peter M. Stevens, MD, professor of orthopaedic surgery, department of orthopaedics, University of Utah, Salt Lake City; Kevin S. Masters, PhD, assistant professor of psychology, department of psychology, Utah State University, Logan, Utah; and Mark Young, MBA, administrative director of finance, Primary Children's Medical Center, Salt Lake City, Utah.