In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States.

Jeffrey D Voigt,Bryan Huber,Michael Mosier

doi:10.1186/1472-6963-14-203

Abstract

BackgroundThe purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VSI]) can provide for improved diagnostic assessment and; more cost effective care.MethodsData on arthroscopy procedures in the US for deep seated pathology in the knee and shoulder were used (Calendar Year 2012). These procedures represent approximately 25-30% of all arthroscopic procedures performed annually. Sensitivities, specificities, positive predictive, and negative predictive values for MRI analysis of this deep seated pathology from systematic reviews and meta-analyses were used in assessing for false positive and false negative MRI findings. The costs of performing diagnostic and surgical arthroscopy procedures (using 2013 Medicare reimbursement amounts); costs associated with false negative findings; and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were then assessed.ResultsIn patients presenting with medial meniscal pathology (ICD9CM diagnosis 836.0 over 540,000 procedures in CY 2012); use of the VSI system in place of MRI assessment (standard of care) resulted in a net cost savings to the system of $151 million. In patients presenting with rotator cuff pathology (ICD9CM 840.4 over 165,000 procedures in CY2012); use of VSI in place of MRI similarly saved $59 million. These savings were realized along with more appropriate care as; fewer patients were exposed to higher risk surgical arthroscopic procedures.ConclusionsThe use of an in-office arthroscopy system can: possibly save the US healthcare system money; shorten the diagnostic odyssey for patients; potentially better prepare clinicians for arthroscopic surgery (when needed) and; eliminate unnecessary outpatient arthroscopy procedures, which commonly result in surgical intervention.

Highlights

The purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VisionScope System (VSI)]) can provide for improved diagnostic assessment and; more cost effective care
Magnetic resonance imaging (MRI) (A) assessment has associated drawbacks, including a relatively high incidence of false negative [FN] (i.e. Pathology shown to be negative on MRI when in actuality pathology is present) and false positive [FP] (i.e. Pathology shown to be present on MRI when in actuality there is none) findings
These recommendations and clinician skepticism are reflected in the following fact: 99% of arthroscopies in the US are therapeutic in nature [15]

Summary

Introduction

The purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VSI]) can provide for improved diagnostic assessment and; more cost effective care. The high incidence of FP and FN occurs most commonly with deep intra-articular structures such as the medial meniscus of community setting (where most MRIs are performed) [3,4,5,6]. What these sensitivities and specificities mean in knee pathology is that in approximately one out of every 5 cases (or 100% less 81% specificity value above = 19%; which is the FP value) of a positive MRI finding for a medial meniscus lesion, there may not be a lesion present. An alternative more accurate diagnostic modality might mitigate some of the above issues

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