Costs of shoulder and elbow procedures are significantly reduced in ambulatory surgery centers compared to hospital outpatient departments.

Abstract

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. 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. 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. 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.