Summary

Patient out-of-pocket expenditures for hip arthroscopy have been increasing at a higher rate than immediate procedure reimbursement, placing a larger economic burden for the surgery on the patient.

Abstract

Introduction

Hip arthroscopy (HA) is a minimally invasive surgical treatment option ideal for patients presenting with symptomatic labral tears and femoroacetabular impingement (FAI). Incidence of FAI has consistently increased over the past two decades and is often observed in athletic patients who engage in high levels of physical activity at a younger age. The procedure’s high rate of return to sports among athletes, superior patient-reported outcome scores relative to that of traditional open surgical hip dislocation, and higher cost-effectiveness when compared with non-operative treatment options have contributed to its significant growth. However, the immediate procedure reimbursement (IPR), expected patient out-of-pocket expenditure (POPE), and surgeon reimbursement (SR) for HA have not yet been characterized in the literature. The purpose of this study is to report on trends in IPR, POPE, and SR for HA.

Methods

Adult Patients undergoing outpatient HA were identified using Current Procedural Terminology codes from the 2013-2017 IBM MarketScan Commercial Claims Encounter database. Median IPR, POPE, and SR were calculated for each cohort: femoroacetabular impingement (FAI) surgery, isolated debridement, and isolated labral repair. A multivariable model was utilized to determine trends over time for IPR, POPE, and SR while controlling for network status of the surgeon and facility, presence of peripheral nerve block, and region of the U.S. that the patient is from. A generalized linear mixed model with a gamma distribution and a log link function was chosen because the outcome variables were skewed. Statistical significance was set at p<0.05. All values were inflation-adjusted to 2017 dollars.

Results

A total of 20,335 patients were identified with 3,739 in the debridement cohort, 14,583 in the FAI cohort, and 2,013 in the labral repair cohort. Multivariable analysis for FAI revealed an increasing trend for IPR and POPE while no significant trend was observed for SR. Median IPR increased 4.2% from $12,316 in 2013 to $12,823 in 2017 (p<0.01) while POPE increased 24.3% from $712 to $885 (p<0.01). No significant trend was observed for SR. For isolated debridement, there was a decreasing trend for IPR, but no significant trend for POPE or SR. Median IPR decreased 13.5% from $7,938 in 2013 to $6,867 in 2017 (p=0.01). For isolated labral repair, no significant trend was observed for IPR, POPE, or SR.

Conclusion

From 2013-2017, IPR and POPE significantly increased for FAI surgery, the largest HA cohort. However, no significant trend was observed for SR. The increase in POPE may be related to growth in high deductible health plans and the overall trend of patients bearing a higher share of procedural costs. In conclusion, this study shows that patients are faced with covering a larger proportion of their HA procedure, adding to the burden of healthcare expenditures on patients. This study also allows for surgeons to better counsel patients on their expected out-of-pocket costs for HA as this is the first study in the literature to evaluate POPE for HA.