A study presented at the AAOS 2024 Annual Meeting reported that ambulatory surgery centers (ASCs) exhibited cost-effectiveness across various hand and upper-extremity procedures, from total expenses to Medicare reimbursements, when compared with hospital outpatient departments (HOPDs).

As explained by Shelby Smith, MD, presenting author and resident physician in the Department of Orthopaedic Surgery at Rush University Medical Center, “Outpatient settings are increasingly utilized across all subspecialities of orthopaedics and demonstrate significant cost savings when compared to inpatient settings. Furthermore, outpatient settings such as ASCs and HOPDs differ in costs and time efficiency in areas such as sports medicine.” Dr. Smith noted that the limited literature examining the cost differences between ASCs and HOPDs, specifically in regard to hand and upper-extremity surgeries, was the catalyst of the study.

Dr. Smith and colleagues utilized publicly available data from the Centers for Medicare & Medicaid Services, accessed through the Medicare Procedure Price Lookup Tool. They used CPT codes to identify hand and upper-extremity procedures. Data on total costs, facility fees, surgeon fees, Medicare payments, and patient payments were extracted for each procedure. Descriptive statistics were employed to calculate means and standard deviations. Differences between ASC- and HOPD-associated costs were analyzed with the Mann-Whitney U test.

The study identified 37 individual CPT codes, which were further categorized into arthroscopy, fracture, arthroplasty/arthrodesis, and other procedures. Arthroscopy procedures demonstrated significant cost savings in various aspects when performed at ASCs compared with HOPDs. The total cost of the procedure ($1,886 versus $3,418; P = 0.009), facility fees ($1,360 versus $2,892; P = 0.021), Medicare payments ($1,509 versus $2,734; P = 0.021), and patient payments ($376.75 versus $682.75; P = 0.021) were all significantly lower in ASCs.

Fracture procedures also exhibited significant cost savings in ASCs. Total costs ($3,886.58 versus $5,975.92; P = 0.021), Medicare payments ($3,109.17 versus $4,780.75; P = 0.021), facility fees ($3,055.17 versus $5,228.67; P = 0.018), and patient payments ($776.92 versus $1,194.75; P = 0.021) were all significantly lower in ASCs.

When considering all CPT codes together, procedures performed at ASCs resulted in approximately 35 percent savings in total cost, 41 percent savings for facility fees, 36 percent savings in Medicare payments, and 28 percent savings in patient payments compared with HOPDs.

“I believe the amount in which ASCs are more cost-efficient than HOPDs for patients, Medicare, and facilities is up to 45% in some areas,” Dr. Smith said. As such, “If both ASCs and HOPDs are available to surgeon and patient alike, a more cost-efficient facility such as an ASC should be considered for common outpatient hand and upper-extremity procedures.”

Future studies, according to Dr. Smith, “could compare other components of these outpatient settings in an effort to see how they differ, such as time efficiency, functional/clinical outcomes, infection rates, and patient satisfaction.”

As far as the study’s limitations, Dr. Smith acknowledged those that are inherent to database studies. Additionally, the study “applies to the Medicare patient population only and is not reflective of those with private insurance,” she said. Also, “We cannot make comments on how these two settings compare in terms of clinical outcomes, as this was not evaluated in this study.”

The study underscores the potential for significant cost savings in outpatient orthopaedic procedures, particularly in ASCs compared to HOPDs. The findings suggest that transitioning certain procedures to ASCs could be a viable strategy for reducing overall healthcare expenditures without compromising quality of care.

Dr. Smith’s coauthors of “Hand and Upper Extremity Procedures Are Significantly More Cost Effective when Performed in Ambulatory Surgery Centers versus Hospital Outpatient Departments” are James Nie, BS; John Higgins, MD; Vince Morgan, MD; Vincent Federico, MD; and Xavier C. Simcock, MD.

Cailin Conner is the associate editor of AAOS Now. She can be reached at cconner@aaos.org.