Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement
Kahlenberg CA, Han B, Patel RM, Deshmane PP, Terry MA. Orthopaedic Journal of Sports Medicine 2014 2(3):2325967114523916.
Take Home Message: Diagnosing labral tears with femoroacetabular impingement can be slow and expensive, it is important for health care professionals to quickly recognize and manage the symptoms.
Femoroacetabular impingement (FAI) and labral tears are the most common causes of non-arthritic hip pain in an active population. Diagnosis of these conditions is often delayed as we try to rule out other diagnoses; but, this delay could be costly and expose a patient to prolonged periods of pain and increase their risk for long-term adverse health effects. If we had a better understanding of how patients were evaluated and treated for FAI and labral tears then this might help us identify strategies to improve patient care and reduce cost. Therefore, these authors set out to determine the average time and money spent by an individual leading up to a diagnosis of a labral tear associated with FAI. One hundred consecutive patients who were diagnosed by a surgeon with a labral lesion associated with FAI (early 2012) were asked to fill out a questionnaire regarding the course of their hip problems prior to diagnosis. The authors excluded 22 individuals who had other injuries (e.g., lumbar spine complaints). Questions included the length of time experiencing symptoms before visiting a health care professional, number of and type of health care providers visited, length of time to diagnosis after initiating care, number and type of imaging tests obtained, and number and type of symptom management methods used. The authors estimated the costs for diagnostic testing and health care provider visits by using the Medicare Technical Component and Medicare (2012 costs). On average, a patient visited 4 health care providers before being seen by a surgeon, at an average cost of $315.05 per patient. A patient on average underwent 3.4 diagnostic tests to obtain the diagnosis at an average cost of $837.01. Patients generally received a labral tear diagnosis 32.0 months after the onset of symptoms. In that time, a patient on average tried 3.1 conservative treatments for an average cost of $1375.44.
These results highlight an unsettling trend in the current diagnosis and treatment of FAI. Even more alarming is that the cost associated with diagnosis and treatment of labral tears with FAI is likely underestimated by this study because they relied on Medicare payments instead of actual hospital charges. Based upon Medicare expense data (2012), the minimum cost to diagnose a labral tear (requires AP pelvis and lateral hip radiograph, MR arthrogram, and a visit to an orthopaedic surgeon) is $690.62. In comparison, the average cost prior to diagnosis in this study was $2456.97, nearly 3 times higher. It will be interesting to see if these findings are true in other areas of the United States. It is important for us to more efficiently diagnose and effectively treat FAI and labral tears. Some of the most commonly reported symptoms were groin pain and the need to limit running activities. Other problematic activities include entering/exiting a vehicle, prolonged sitting, and stair climbing. These signs may be common to multiple different orthopaedic injuries, which may be a contributing factor to length to diagnosis. However, this study supports that an individual exhibiting these prolonged signs would likely benefit from earlier attempts to rule out labral involvement.
Questions for Discussion: How might this information factor into your clinical practice when dealing with similar patients? Have your heard similar complaints from patients regarding unclear diagnoses? If so, how have you handled this situation?
Written by: Meghan Maume Miller
Reviewed by: Jeffrey Driban