Do All Outpatient Surgery Cost the Same? State-Analysis of Index Admission and Subsequent Cumulative Costs for Patients Undergoing Outpatient ACDF in an Ambulatory Surgical Center (ASC) vs a Hospital Outpatient Facility. (16th November 2020)

• Record Type: Journal Article
• Authors: Bydon, Mohamad; Alvi, Mohammed A; Kurian, Shyam; Jeffery, Molly; Naessens, James; Spinner, Robert J
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_120
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Outpatient surgery has been touted to have significant cost benefits over inpatient surgery. However, it remains unclear whether these cost benefits are uniform across ASCs and hospital outpatient facilities METHODS: The Florida State Ambulatory Surgery Database (SASD) for the years 2012–2014 was queried for patients undergoing ACDF for degenerative disease. The cohort was grouped by the facility type into Ambulatory Surgery Center (ASC) and hospital outpatient. Costs were analyzed as 1) admission costs, as well as 2) 7-day 3) 30-day and 4) 90-day cumulative costs, to account for patients with subsequent readmissions to outpatient facility, inpatient facility and emergency department. Sensitivity analyses were also performed, subsetting the cohort for only those patients <65 years who had private insurance, given that prior to 2015, Center for Medicare and Medicaid Services (CMS) had not released an official outpatient prospective system structure for ACDF. RESULTS: A total of 3, 924 patients were identified, of which 35.2% (1, 382) underwent ACDF at an ASC while 64.8% (n = 2, 542) underwent the procedure in a hospital outpatient facility. The majority insurance type for both settings was private insurance (ASC: 65.6% vs 69.6%); however, medicaid patients made up a higher percentage of individuals in the hospital outpatient setting (13.5%) compared to ASCs (1.7%), while self-pay made up a higher proportion of ASC patients (15.5%) than patient in the hospital outpatient setting (2.2%). The index admission costs was found to be significantly higher for ASC ACDF ($72, 575.4 (SD = 441.7) vs $59, 056.7 (SD = 24, 862), P < . 001). We also observed a significant difference in 30-day (ASC: $60, 668.6 (SD = 132396.8) vs $22, 530.1 (SD = 41592.1), P = . 012), and 30-day (ASC: $48, 787.9 (SD = 108, 904.9) vs $22, 578.9 (41708.9), P = . 013). These differences were more pronounced when we selected only patients on private insurance (index admission: ASC $76775.8 (SD = 45910) vs $59, 315.231 (23583.090), P < . 001; 7-day: $27, 086.7 (SD = 39, 561.5) vs $13802.660 (SD = 29, 426.3), P = . 07; 30-day: $59, 523.906 (SD = 13, 1382.1) vs $22, 530.1 (SD = 41, 592.1); 90-day: $59, 523.9 (SD = 131, 382.1) vs 22, 530.1 (SD = 41, 592.1), P = . 01). CONCLUSION: These results indicate that ASCs may cost significantly higher than hospital-outpatient for routine ACDFs. These results may help policy makes and stake-holders to design future policies.