Hand and Upper Extremity Procedures Are Significantly More Cost Effective When Performed in Ambulatory Surgery Centers Versus Hospital Outpatient Departments

Abstract

Objective

Orthopaedic surgery has high rate of utilization of the outpatient settings including ambulatory surgery centers (ASC) and hospital outpatient departments (HOPD). We seek to compare costs at these outpatient facilities, ASC versus HOPD, for hand and upper extremity procedures.

Design/Setting:

Database review was performed with publicly available data from Center for Medicare and Medicaid Services (CMS) via the Medicare Procedure Price Lookup Tool and Current Procedural Terminology (CPT) codes for hand and upper extremity procedures. Total costs, facility fees, Medicare payments, and patient payments were obtained for each procedure code. Descriptive statistics were used to calculate means and standard deviations. Differences were analyzed using Mann Whitney U test.

Results:

Thirty-seven CPT codes were divided into arthroscopy, fracture, arthroplasty/arthrodesis, and other. Arthroscopy demonstrated cost savings in total cost of procedure (1,886.00±58.72 vs 3,418.00±58.78; p=0.009), facility fees (1,360.00±0 vs 2,892.00±0; p=0.021), Medicare payments (1,509.00±47.27 vs 2,734.00±47.27 p=0.021), and patient payments (376.75±11.87 vs 682.75±11.87; p=0.021) in ASCs compared to HOPD. Fracture procedures had lower total costs (3,886.58±1,527.61 vs 5,975.92±1,890.96; p=0.021), Medicare payments (3,109.17±1,221.21 vs 4,780.75±1,511.90; p=0.021), facility fees (3,055.17±1,503.23 vs 5,228.67±1,725.74; p=0.018), and patient payments (776.92±305.46 vs 1,194.75±377.97; p=0.021) in ASCs. When CPT codes were grouped all together, there was 35% savings in total cost, 41% savings for facility fees, and 36% savings in Medicare payments, and 28% in patient payments for procedures performed at ASCs.

Conclusion:

ASCs demonstrate cost-savings across multiple procedures for the hand and upper extremity in a variety of areas including total costs, facility fees, Medicare payments, and patient payments when compared to HOPDs.