AN EVALUATION OF THE FISCAL IMPACT OF THYROID AND PARATHYROID
SURGERIES ON THE TRAUMA SURGICAL SERVICES DEPARTMENT
Robert Grossman, MD and Andrew Rosenthal, MD MBA FACS
Memorial Regional Hospital, Hollywood, FL
Background: In light of a constantly changing environment in U.S. health care, trauma centers
are under increasing pressure to become a financially productive asset of their parent institutions.
For this reason among others, most divisions of trauma have an active general surgery practice
incorporated into the schedule and budget. In addition to general surgery, our trauma practice has
additionally incorporated the surgery of thyroid and parathyroid disease and we sought to
investigate the financial impact of this addition on our department.
Setting: A level 1 trauma center and teaching institution in metropolitan South Florida
Objectives: To evaluate the fiscal impact of incorporating the surgery of thyroid and parathyroid
disease into a trauma practice with a previously established general surgery practice.
Methods: Retrospective identification of thyroidectomy and parathyroidectomy operations
performed by members of the trauma service were collected and analyzed for CMS (Medicare)
CPT code, with subsequent summation of surgeon reimbursement used as an indication of added
revenue brought to the department. The non-surgeon charges associated with treatment, such as
the institutional fees for the operation, anesthesia, postoperative stay, laboratory and imaging
services were excluded from this study. Subjective estimates specific to the diagnosis and
procedure performed were made for average total time dedicated to the patient by the surgeon,
including preoperative evaluation, intraoperative duration, and postoperative care.
Results: 200 thyroid and 65 parathyroid surgeries were performed from the period January 1,
2007-December 31, 2014. Of the thyroid resections, 62 operations were categorized as “partial
removal of thyroid” (CPT 60220, thyroid unilateral lobectomy), 70 as “removal of thyroid” (CPT
60240, total thyroidectomy without lymphadenectomy), 43 as “removal of thyroid, malignancy,
limited neck dissection” (CPT 60252), and 25 operations as “Repeat thyroid surgery” (CPT
60260, completion thyroidectomy). All 65 parathyroid operations were categorized as
“exploration of parathyroid glands” (CPT 60500, parathyroidectomy).
Medicare reimbursement and estimates of time dedicated to the patient are summarized in Table
1 (below):
Mailing address and contact information:
Memorial Regional Hospital
Division of Trauma Services
3501 Johnson Street
Hollywood, FL 33021
954-265-4034 (phone)
954-983-2041 (fax)
lkerr@mhs.net (correspondence email)
Table 1: Reimbursement and surgeon time per diagnostic procedure
Reimbursement
Estimated Surgeon Time
CPT Code
(US$)
(Global Period in hours)
60220
795
3.5
60240
1036
4
60252
1484
5
60260
1229
5
60500
1090
3
Revenue was grossly estimated by multiplying the number of operations by the CMS
reimbursement for that procedure, which totaled $216,347 for thyroid procedures and $70,850
for parathyroid procedures. Total sum reimbursement for thyroidectomy and parathyroidectomy
procedures was thus estimated as $287,197 for a period spanning 7 years, averaging roughly
$41,000 annually. Total dedicated surgeon global time including preoperative evaluation,
intraoperative time, and postoperative treatment was estimated to be 1032 hours, averaging about
147 hours annually.
Conclusion: Incorporating thyroidectomy and parathyroidectomy into the general surgery
practice of our trauma division has added roughly $41,000 annually to our department billing.
This financial revenue is balanced (offset) by the significant time required to address the
preoperative, intraoperative and postoperative needs of this patient population, which must be
considered in light of limited trauma department staffing and resources.
Limitations: To simplify a financial hypothesis, patients were assumed to have Medicare
coverage.