Cost Analysis and Reimbursement of Weightbearing Computed Tomography

Nathaniel B Alexander; Shumaila Sarfani; Carson D Strickland; David R Richardson; G Andrew Murphy; Benjamin J Grear; Clayton C Bettin

doi:10.1177/24730114231164143

Cost Analysis and Reimbursement of Weightbearing Computed Tomography

Foot Ankle Orthop. 2023 Mar 27;8(1):24730114231164143. doi: 10.1177/24730114231164143. eCollection 2023 Jan.

Authors

Nathaniel B Alexander¹, Shumaila Sarfani², Carson D Strickland³, David R Richardson¹, G Andrew Murphy¹, Benjamin J Grear¹, Clayton C Bettin¹

Affiliations

¹ Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA.
² Ortho San Antonio, San Antonio, TX, USA.
³ Mid Tennessee Bone and Joint, Columbia, TN, USA.

Abstract

Background: Weightbearing computed tomography (WBCT) is becoming a valuable tool in the evaluation of foot and ankle pathology. Currently, cost analyses of WBCT scanners in private practice are lacking in the literature. This study evaluated the costs of acquisition, utilization, and reimbursements for a WBCT at a tertiary referral center, information of particular interest to practices considering obtaining such equipment.

Methods: All WBCT scans performed at a tertiary referral center over the 55-month period (August 2016 to February 2021) were retrospectively evaluated. Patient demographics, pathology location, etiology, subspecialty of the ordering provider, and whether the study was unilateral or bilateral were collected. Reimbursement was calculated based on payor source as a percentage of Medicare reimbursement for lower extremity CT. The number of total scans performed per month was evaluated to determine revenue generated per month.

Results: Over the study period, 1903 scans were performed. An average of 34.6 scans were performed each month. Forty-one providers ordered WBCT scans over the study period. Foot and ankle fellowship-trained orthopaedic surgeons ordered 75.5% of all scans. The most common location of pathology was the ankle, and the most common etiology was trauma. The device was cost neutral at 44.2 months, assuming reimbursement for each study was commensurate with Medicare rates. The device became cost neutral at approximately 29.9 months when calculating reimbursement according to mixed-payor source.

Conclusion: As WBCT scan becomes more widely used for evaluation of foot and ankle pathology, practices may be interested in understanding the financial implications of such an investment. To the authors' knowledge, this study is the only cost-effectiveness analysis of WBCT based in the United States. We found that in a large, multispecialty orthopaedic group, WBCT can be a financially viable asset and a valuable diagnostic tool for a variety of pathologies.

Level of evidence: Level III, diagnostic.

Keywords: CT scanner; Medicare; acquisition and utilization; cost analysis; foot and ankle; reimbursement; weightbearing computed tomography (CT).