Abstract：
OBJECTIVE: To categorize and trend annual out-of-pocket expenditures for arthroscopic rotator cuff repair (RCR) patients relative to total healthcare utilization (THU) reimbursement and compare drivers of patient out-of-pocket expenditures (POPE) in a granular fashion via analyses by insurance type and surgical setting.
METHODS: Patients who underwent outpatient arthroscopic RCR in the United States from 2013 to 2018 were identified from the IBM MarketScan Database. Primary outcome variables were total POPE and THU reimbursement, which were calculated for all claims in the 9-month perioperative period. Trends in outcome variables over time and differences across insurance types were analyzed. Multivariable analysis was performed to investigate drivers of POPE.
RESULTS: A total of 52,330 arthroscopic RCR patients were identified. Between 2013 and 2018, median POPE increased by 47.5% ($917 to $1,353), and median THU increased by 9.3% ($11,964 to $13,076). Patients with high deductible insurance plans paid $1,910 toward their THU, 52.5% more than patients with preferred provider plans ($1,253, P = .001) and 280.5% more than patients with managed care plans ($502, P = .001). All components of POPE increased over the study period, with the largest observed increase being POPE for the immediate procedure (P = .001). On multivariable analysis, out-of-network facility, out-of-network surgeon, and high-deductible insurance most significantly increased POPE.
CONCLUSIONS: POPE for arthroscopic RCR increased at a higher rate than THU over the study period, demonstrating that patients are paying an increasing proportion of RCR costs. A large percentage of this increase comes from increasing POPE for the immediate procedure. Out-of-network facility status increased POPE 3 times more than out-of-network surgeon status, and future cost-optimization strategies should focus on facility-specific reimbursements in particular. Last, ambulatory surgery centers (ASCs) significantly reduced POPE, so performing arthroscopic RCRs at ASCs is beneficial to cost-minimization efforts.
CONCLUSIONS: This study highlights that although payers have increased reimbursement for RCR, patient out-of-pocket expenditures have increased at a much higher rate. Furthermore, this study elucidates trends in and drivers of patient out-of-pocket payments for RCR, providing evidence for development of cost-optimization strategies and counseling of patients undergoing RCR.
METHODS: Patients who underwent outpatient arthroscopic RCR in the United States from 2013 to 2018 were identified from the IBM MarketScan Database. Primary outcome variables were total POPE and THU reimbursement, which were calculated for all claims in the 9-month perioperative period. Trends in outcome variables over time and differences across insurance types were analyzed. Multivariable analysis was performed to investigate drivers of POPE.
RESULTS: A total of 52,330 arthroscopic RCR patients were identified. Between 2013 and 2018, median POPE increased by 47.5% ($917 to $1,353), and median THU increased by 9.3% ($11,964 to $13,076). Patients with high deductible insurance plans paid $1,910 toward their THU, 52.5% more than patients with preferred provider plans ($1,253, P = .001) and 280.5% more than patients with managed care plans ($502, P = .001). All components of POPE increased over the study period, with the largest observed increase being POPE for the immediate procedure (P = .001). On multivariable analysis, out-of-network facility, out-of-network surgeon, and high-deductible insurance most significantly increased POPE.
CONCLUSIONS: POPE for arthroscopic RCR increased at a higher rate than THU over the study period, demonstrating that patients are paying an increasing proportion of RCR costs. A large percentage of this increase comes from increasing POPE for the immediate procedure. Out-of-network facility status increased POPE 3 times more than out-of-network surgeon status, and future cost-optimization strategies should focus on facility-specific reimbursements in particular. Last, ambulatory surgery centers (ASCs) significantly reduced POPE, so performing arthroscopic RCRs at ASCs is beneficial to cost-minimization efforts.
CONCLUSIONS: This study highlights that although payers have increased reimbursement for RCR, patient out-of-pocket expenditures have increased at a much higher rate. Furthermore, this study elucidates trends in and drivers of patient out-of-pocket payments for RCR, providing evidence for development of cost-optimization strategies and counseling of patients undergoing RCR.
摘要：
目的：对关节镜肩袖修复（RCR）患者的年度自付支出相对于总医疗保健利用（THU）报销进行分类和趋势，并通过按保险类型和手术设置进行分析，以细粒度的方式比较患者自付支出（POPE）的驱动因素。
方法：从IBMMarketScan数据库中确定了2013年至2018年在美国接受门诊关节镜RCR的患者。主要结果变量是总POPE和THU报销，计算了9个月围手术期的所有索赔。分析了结果变量随时间的趋势以及保险类型之间的差异。进行多变量分析以调查POPE的驱动因素。
结果：共有52,330例关节镜下RCR患者被确认。2013年至2018年，POPE中位数增长了47.5%（917美元至1353美元），和中位数THU增长9.3%（11,964美元至13,076美元）。具有高免赔额保险计划的患者向他们的THU支付了1,910美元，比首选提供者计划的患者多52.5%（$1,253，P=.001），比管理式护理计划的患者多280.5%（$502，P=.001）。POPE的所有成分在研究期间都有所增加，观察到的最大增加是立即手术的POPE(P=.001)。在多变量分析中，网络外设施，网络外的外科医生，和高免赔额保险最显著提高POPE。
结论：POPE用于关节镜RCR在研究期间以高于THU的速率增加，证明患者支付的RCR费用比例越来越高。这种增加的很大一部分来自立即程序的增加POPE。网络外设施状态比网络外外科医生状态增加了3倍，未来的成本优化战略应特别侧重于特定于设施的报销。最后,门诊手术中心（ASC）显着减少POPE，因此，在ASCs上进行关节镜RCR有利于成本最小化。
结论：这项研究强调，尽管付款人增加了对RCR的报销，患者自付支出以更高的速度增长。此外，这项研究阐明了RCR患者自付费用的趋势和驱动因素，为制定RCR患者的成本优化策略和咨询提供证据。
方法：从IBMMarketScan数据库中确定了2013年至2018年在美国接受门诊关节镜RCR的患者。主要结果变量是总POPE和THU报销，计算了9个月围手术期的所有索赔。分析了结果变量随时间的趋势以及保险类型之间的差异。进行多变量分析以调查POPE的驱动因素。
结果：共有52,330例关节镜下RCR患者被确认。2013年至2018年，POPE中位数增长了47.5%（917美元至1353美元），和中位数THU增长9.3%（11,964美元至13,076美元）。具有高免赔额保险计划的患者向他们的THU支付了1,910美元，比首选提供者计划的患者多52.5%（$1,253，P=.001），比管理式护理计划的患者多280.5%（$502，P=.001）。POPE的所有成分在研究期间都有所增加，观察到的最大增加是立即手术的POPE(P=.001)。在多变量分析中，网络外设施，网络外的外科医生，和高免赔额保险最显著提高POPE。
结论：POPE用于关节镜RCR在研究期间以高于THU的速率增加，证明患者支付的RCR费用比例越来越高。这种增加的很大一部分来自立即程序的增加POPE。网络外设施状态比网络外外科医生状态增加了3倍，未来的成本优化战略应特别侧重于特定于设施的报销。最后,门诊手术中心（ASC）显着减少POPE，因此，在ASCs上进行关节镜RCR有利于成本最小化。
结论：这项研究强调，尽管付款人增加了对RCR的报销，患者自付支出以更高的速度增长。此外，这项研究阐明了RCR患者自付费用的趋势和驱动因素，为制定RCR患者的成本优化策略和咨询提供证据。
