Medicare procedural costs in ambulatory surgery centers versus hospital outpatient departments for spine surgeries

被引:8
作者
Federico, Vincent P. [1 ,3 ]
Nie, James W. [1 ]
Sachdev, Divesh [1 ]
Hartman, Timothy J. [1 ]
Trevino, Noe [1 ]
Gabriel, Samy [2 ]
Butler, Alexander J. [1 ]
Lopez, Gregory D. [1 ]
An, Howard S. [1 ]
Colman, Matthew W. [1 ]
Phillips, Frank M. [1 ]
机构
[1] Rush Univ, Med Ctr, Dept Orthopaed Surg, Chicago, IL USA
[2] Univ Calif San Diego, Dept Orthopaed Surg, San Diego, CA USA
[3] Rush Univ, Med Ctr, Chicago, IL 60612 USA
关键词
outpatient; ASC; ambulatory surgery center; reimbursement; spine surgery; minimally invasive; LUMBAR INTERBODY FUSION; REIMBURSEMENT;
D O I
10.3171/2023.7.SPINE23424
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Multiple studies have demonstrated the safety of outpatient spine surgery, with reports of equivalent to improved patient outcomes compared with inpatient procedures. This has resulted in the increased use of outpatient surgery over time. However, there remains a paucity of literature evaluating the difference in costs between ambulatory surgery center (ASC)- and hospital outpatient department (HOPD)-based procedures for Medicare beneficiaries.Methods: Publicly available data from Centers for Medicare & Medicaid Services were accessed via the Medicare Procedure Price Lookup tool. Current Procedural Terminology (CPT) codes were used to identify spine-specific procedures approved for the outpatient setting by CMS. Procedures were grouped into decompression (cervical, thoracic, and lumbar), fusion/instrumentation (cervical, lumbar, and sacroiliac), and kyphoplasty/vertebroplasty cohorts, as well as an overall cohort. Data regarding total costs, facility fees, surgeon reimbursement, Medicare payments, and patient copayments were extracted for each procedure. Descriptive statistics were used to calculate means and standard deviations. Differences between ASC- and HOPD-associated costs were analyzed using the Mann-Whitney U-test.Results: Twenty-one individual CPT codes approved by Medicare for the ASC and/or HOPD setting were identified. Decompression procedures were associated with a significantly lower total cost ($4183 +/- $411.07 vs $7583.67 +/- $410.89, p < 0.001), facility fees ($2998 +/- $0 vs $6397 +/- $0, p < 0.001), Medicare payments ($3345.75 +/- $328.80 vs $6064.75 +/- $328.80, p < 0.001), and patient payments ($835.58 +/- $82.13 vs $1515.58 +/- $82.13, p < 0.001) in ASCs compared with HOPDs. Fusion/instrumentation procedures had significantly lower facility fees ($10,436.6 +/- $2347.51 vs $14,161 +/- $2147.07, p = 0.044) and Medicare payments ($9501.2 +/- $1732.42 vs $13,757 +/- $2037.58, p = 0.009) in ASCs, as well as a trend toward lower total costs ($11,876.8 +/- $2165.22 vs $15,601.2 +/- $2016.06, p = 0.076). Patient payments in the HOPD setting were significantly lower in the fusion/instrumentation cohort ($1843.6 +/- $73.42 vs $2374.4 +/- $433.48, p = 0.009). In the kyphoplasty/vertebroplasty cohort, there was no statistically significant difference between ASCs and HOPDs, despite lower overall costs in the ASC for all variables. Surgeon fees were the same regardless of setting for all procedures (p > 0.99). When combining decompression, fusion/instrumentation, and kyphoplasty/vertebroplasty CPT codes into a single cohort, ASC setting was associated with significant cost savings in total cost, facility fees, Medicare payments, and patient payments.Conclusions: In general, performing spine surgeries in ASCs is associated with cost savings compared with HOPDs. This was demonstrated for decompression and fusion/instrumentation, and kyphoplasty/vertebroplasty Medicare-approved outpatient procedures.
引用
收藏
页码:115 / 120
页数:6
相关论文
共 48 条
[41]   A Comparison of Narcotic Consumption Between Hospital and Ambulatory-Based Surgery Centers Following Anterior Cervical Discectomy and Fusion [J].
Massel, Dustin H. ;
Narain, Ankur S. ;
Hijji, Fady Y. ;
Mayo, Benjamin C. ;
Bohl, Daniel D. ;
Lopez, Gregory D. ;
Singh, Kern .
INTERNATIONAL JOURNAL OF SPINE SURGERY, 2018, 12 (05) :595-602
[42]   Spinal Versus General Anesthesia for Outpatient Total Hip and Knee Arthroplasty in the Ambulatory Surgery Center: A Matched-Cohort Study [J].
Calkins, Tyler E. ;
Johnson, Evan P. ;
Eason, Robert R. ;
Mihalko, William M. ;
Ford, Marcus C. .
JOURNAL OF ARTHROPLASTY, 2024, 39 (06) :1463-1467
[43]   Endoscopic Third Ventriculostomy and Endoscopic Intracranial Cyst Fenestration in an Outpatient Ambulatory Surgery Center Yields Reduced Cost But Equal Efficacy and Safety Compared with Surgery in the Hospital [J].
Atkins, Tyler G. ;
Peters, David R. ;
Jernigan, Sarah C. ;
Henegar, Martin M. ;
Van Poppel, Mark D. ;
Wait, Scott D. .
WORLD NEUROSURGERY, 2021, 156 :E160-E166
[44]   A matched-cohort study comparing outpatient total knee arthroplasty in an ambulatory surgery center with inpatient total knee arthroplasty in a hospital [J].
Littleton, Travis W. ;
Mascioli, Anthony A. ;
Throckmorton, Thomas W. ;
Mihalko, William M. ;
Toy, Patrick C. .
CURRENT ORTHOPAEDIC PRACTICE, 2020, 31 (05) :474-478
[45]   Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 2: Assessment of Surgical Safety in Medicare Beneficiaries [J].
Schlesinger, Scott M. ;
Maggio, Dominic ;
Lorio, Morgan P. ;
Lewandrowski, Kai-Uwe ;
Block, Jon E. .
JOURNAL OF PERSONALIZED MEDICINE, 2023, 13 (03)
[46]   Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study [J].
Brolin, Tyler J. ;
Mulligan, Ryan P. ;
Azar, Frederick M. ;
Throckmorton, Thomas W. .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2017, 26 (02) :204-208
[47]   Primary single-level lumbar microdisectomy/decompression at a free-standing ambulatory surgical center vs a hospital-owned outpatient department-an analysis of 90-day outcomes and costs [J].
Malik, Azeem Tariq ;
Xie, Jack ;
Retchin, Sheldon M. ;
Phillips, Frank M. ;
Xu, Wendy ;
Yu, Elizabeth ;
Khan, Safdar N. .
SPINE JOURNAL, 2020, 20 (06) :882-887
[48]   Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen [J].
Hansen, Ryan N. ;
Pham, An T. ;
Boing, Elaine A. ;
Lovelace, Belinda ;
Wan, George J. ;
Miller, Timothy E. .
CURRENT MEDICAL RESEARCH AND OPINION, 2017, 33 (05) :943-948