title: Financial implications of nonoperative fracture care at an academic trauma center.
abstract: OBJECTIVE
  To determine if nonoperative fracture Current Procedural Technology codes generate a significant portion of annual revenues in an academic practice.
  
  
  METHODS
  Retrospective review of an orthopaedic trauma practice billings during fiscal year 2008.
  
  
  METHODS
  An urban level-1 trauma center.
  
  
  METHODS
  Outpatient clinic, and all consults, to the orthopaedic trauma service in the emergency room and hospital wards staffed by an attending traumatologist.
  
  
  METHODS
  An analysis was made of relative value units (RVUs) generated by operative and nonoperative care, separating the later into clinic, consults, and closed (nonoperative) fracture treatment.
  
  
  RESULTS
  A total of 19,815 RVUs were generated by the trauma service during the 2008 fiscal year. Emergency department and ward consults generated 2176 (11%) of RVUs, whereas outpatient clinic generated an additional 1313 (7%) of RVUs. Nonoperative (closed) fracture care generated 2725 (14%) RVUs, whereas surgical procedures were responsible for the remaining 13,490 (68%) of RVUs. In terms of overall financial reimbursement, nonoperative management, consults, and office visits generated 31% of income for the trauma service.
  
  
  CONCLUSIONS
  Although the largest financial contribution to a busy surgical practice is operative procedures, 1 must not overlook the important impact of nonoperative fracture care and consults. In our academic center, nearly one-third of all income was generated from nonsurgical procedures. In the current medical/financial climate, 1 must be diligent in optimizing the finances of trauma care to sustain an economically viable practice.
  
  
  METHODS
  Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA, USA. pappleto@bidmc.harvard.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Appleton
authors.forename: Aron
authors.initials: A
authors.lastname: Chacko
authors.forename: Edward K
authors.initials: EK
authors.lastname: Rodriguez
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005251:Fees, Medical / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D014194:Traumatology / Q000191:economics*; D055815:Young Adult