Journal of Orthopaedic Business

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

Vincent P. Federico, Shelby R. Smith, John Higgins, Vince Morgan, Xavier Simcock — Mon, 01 Jul 2024 00:00:00 -0700

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.

Cost of TKA implant averages $5,336 and contributes 22% of the total cost of a primary TKA

Mon, 01 Jul 2024 00:00:00 -0700

Objectives: The purpose of this study is to characterize the percent contribution of the cost of the standard knee implant to the total cost of a primary TKA based on currently published literature.

Design: Systematic literature review.

Main outcome measurement: cost in $USD inflation adjusted

Results: PubMed search produced 469 articles regarding “total knee arthroplasty implant cost” of which 14 had novel estimates for cost of the standard knee implant and total cost of primary TKA. The mean cost of the standard knee implant was $5,336 ± $1,671 and the mean total cost of primary TKA was $23,907 ± $9,514. The cost of the standard knee implant contributes to 22.3% of the total cost of a primary TKA.

Conclusion:

Published estimates of standard knee implant costs are highly variable. The best estimate based on literature is $5,336 ± $1,671 contributing to 22.3% of the total cost of a primary TKA, however there is room for improving this estimate.

Level of Evidence: IV; Systematic Review of level IV or higher evidence

Keywords: Business, management, human resources, cost, value, efficiency.

Estimated Cost of Fibrin Glue

Mon, 01 Apr 2024 00:00:00 -0700

Objectives: The purpose of this study is to systematically investigate the current cost/mL of fibrin glue to be used in the operating room based on currently published literature.

Design: Systematic literature review.

Main outcome measurement: Cost in dollars per milliliter.

Results: Literature search produced 500 articles regarding “Fibrin Glue Cost” of which 18 had novel estimates for the cost of fibrin glue per mL. The average cost estimate for fibrin glue among the current literature is $161.61 ± $140.78. With outliers removed it was $122.45 ± $61.90.

Conclusion: Fibrin glue is used in many procedures for its hemostatic, adhesive, and sealant properties. In this literature review study, we found the average cost of fibrin glue to be $161.61/mL with indications that the true cost may be significantly cheaper. It is a financially stable option that has not become more expensive since it came into practice. Future studies are needed to investigate the overall cost benefit analysis.

Level of Evidence: IV; Systematic Review of level IV or higher evidence

Keywords: Business, management, resources, cost, value, efficiency.