背景:最近的文献表明,许多肩和肘手术的门诊手术具有优势,包括在适当选择的患者中具有同等安全性的成本节约。门诊手术的两个常见设置是门诊手术中心(ASC),作为独立的财务和行政实体,或医院门诊部(HOPDs),由医院系统拥有和运营。这项研究的目的是比较ASCs和HOPDs之间的肩部和肘部手术费用。
方法:通过医疗保险程序价格查找工具访问了由医疗保险和医疗补助服务中心(CMS)提供的2022年公开数据。当前程序术语(CPT)代码用于识别CMS批准用于门诊设置的肩部和肘部程序。手术分为关节镜检查,骨折,或杂项。总成本,设施费,医疗保险付款,患者付款(Medicare不包括的费用),并提取了外科医生的费用。描述性统计用于计算平均值和标准偏差。使用MannWhitneyU检验分析了成本差异。
结果:确定了57个CPT代码。ASC的关节镜手术(n=16)总费用显着降低($2,667±989vs4,899±1,917;p=0.009),设施费(1,974±819美元对4,206±1,753;p=0.008),医疗保险付款($2,133±791vs3,919±1,534p=0.009),和患者付款(533±198美元vs979±383;p=0.009),与HOPDs相比。ASC的骨折手术(n=10)总成本较低($7,680±3,123vs11,335±3,830;p=0.049),设施费(6,851±3,033美元对10,507±3,733美元;p=0.047),和医疗保险支付(6,143±2,499美元vs9,724±3,676;p=0.049),与HOPDs相比,尽管患者支付无显著差异($1,535±625vs1,610±160;p=0.449).ASC的杂项程序(n=31)总费用较低($4,202±2,234vs6,985±2,917;p<0.001),设施费(3348±2059美元对6132±2736美元;p<0.001),医疗保险付款(3,361±1,787美元vs5,675±2,635;p<0.001),和患者支付(840±447美元vs1,309±350;p<0.001),与HOPDs相比。ASC的合并队列(n=57)总成本较低($4,381±2,703vs7,163±3,534;p<0.001),设施费(3,577±2,570美元,6,539.1±3,391美元;p<0.001),医疗保险付款(3,504±2,162美元vs5,892±3,206;p<0.001),和患者支付(875±540美元vs1,269±393;p<0.001),与HOPD相比。
结论:与在ASCs进行的手术相比,在HOPDs中对Medicare接受者进行的肩关节和肘关节手术的平均总费用增加了164%(关节镜检查节省了184%,骨折148%,杂项为166%)。ASC使用赋予较低的设施费用,病人付款,和医疗保险支付。鼓励将手术转移到ASC的政策努力可能会节省大量的医疗保健成本。
BACKGROUND: Recent literature has shown the advantages of outpatient surgery for many shoulder and elbow procedures, including cost
savings with equivalent safety in appropriately selected patients. Two common settings for outpatient surgeries are ambulatory surgery centers (ASCs), which function as independent financial and administrative entities, or hospital outpatient departments (HOPDs), which are owned and operated by hospital systems. The purpose of this study was to compare shoulder and elbow surgery costs between ASCs and HOPDs.
METHODS: Publicly available data from 2022 provided by the Centers for Medicare & Medicaid Services (CMS) was accessed via the Medicare Procedure Price Lookup Tool. Current Procedural Terminology (CPT) codes were used to identify shoulder and elbow procedures approved for the outpatient setting by CMS. Procedures were grouped into arthroscopy, fracture, or miscellaneous. Total costs, facility fees, Medicare payments, patient payment (costs not covered by Medicare), and surgeon\'s fees were extracted. Descriptive statistics were used to calculate means and standard deviations. Cost differences were analyzed using Mann-Whitney U tests.
RESULTS: Fifty-seven CPT codes were identified. Arthroscopy procedures (n = 16) at ASCs had significantly lower total costs ($2667 ± $989 vs. $4899 ± $1917; P = .009), facility fees ($1974 ± $819 vs. $4206 ± $1753; P = .008), Medicare payments ($2133 ± $791 vs. $3919 ± $1534; P = .009), and patient payments ($533 ± $198 vs. $979 ± $383; P = .009) compared with HOPDs. Fracture procedures (n = 10) at ASCs had lower total costs ($7680 ± $3123 vs. $11,335 ± $3830; P = .049), facility fees ($6851 ± $3033 vs. $10,507 ± $3733; P = .047), and Medicare payments ($6143 ± $2499 vs. $9724 ± $3676; P = .049) compared with HOPDs, although patient payments were not significantly different ($1535 ± $625 vs. $1610 ± $160; P = .449). Miscellaneous procedures (n = 31) at ASCs had lower total costs ($4202 ± $2234 vs. $6985 ± $2917; P < .001), facility fees ($3348 ± $2059 vs. $6132 ± $2736; P < .001), Medicare payments ($3361 ± $1787 vs. $5675 ± $2635; P < .001), and patient payments ($840 ± $447 vs. $1309 ± $350; P < .001) compared with HOPDs. The combined cohort (n = 57) at ASCs had lower total costs ($4381 ± $2703 vs. $7163 ± $3534; P < .001), facility fees ($3577 ± $2570 vs. $6539.1 ± $3391; P < .001), Medicare payments ($3504 ± $2162 vs. $5892 ± $3206; P < .001), and patient payments ($875 ± $540 vs. $1269 ± $393; P < .001) compared with HOPDs.
CONCLUSIONS: Shoulder and elbow procedures performed at HOPDs for Medicare recipients were found to have average total cost increase of 164% compared with those performed at ASCs (184%
savings for arthroscopy, 148% for fracture, and 166% for miscellaneous). ASC use conferred lower facility fees, patient payments, and Medicare payments. Policy efforts to incentivize migration of surgeries to ASCs may translate into substantial health care cost
savings.