OBJECTIVES: Rising musculoskeletal care costs in the U.S. drive the development of value-based models for patient-centric outcomes. Integrated practice units (IPUs) play a key role, delivering evidence-based strategies in outpatient settings. While IPUs reduce costs for lower extremity conditions, upper extremity conditions' cost drivers are unclear. Our main aim is to estimate total costs for carpal tunnel and trigger finger management using time-driven activity-based costing (TDABC), with secondary goals of identifying key cost drivers and reductions across the care continuum.

METHODS: We employed TDABC to assess carpal tunnel and trigger finger management costs in an IPU. Using process maps and identifying patient-focused activities, personnel, and resources, we calculated times through interviews, stopwatch observations, and electronic records. Capacity cost rates were estimated for personnel, multiplied by process times for direct and indirect costs. Total care costs were then compared to Medicare reimbursement rates for carpal tunnel and trigger finger release.

RESULTS: The costs for IPU-based non-operative carpal tunnel management were $158.11, and operative management was $556.16. Non-operative trigger finger management costs were $136.19, and operative management was $523.36. Both IPU-based operative treatments for carpal tunnel and trigger finger were significantly lower than Medicare national average reimbursement rates. Reasons for lower costs of non-operative management included greater utilization of NPs and PAs over surgeons (Mean NP/PA CCR = $1.39/min vs. Mean Orthopedic Surgeon CCR = $6.71/min). The cost driver for operative treatment was the direct labor costs of the orthopedic surgeon, performing administrative and clinical roles during surgical episodes (median labor time (22 minutes, range: 15-28 minutes) at $148 (range: $101-$188).

CONCLUSIONS: The total costs for carpal tunnel and trigger finger release treatments were significantly below established Medicare reimbursement rates and in-patient surgical procedure costs. This information guides stakeholders in developing holistic care models with evidence-based strategies across the entire care continuum.