Summary

Ambulatory surgery centers (ASCs) provide significant cost savings to the U.S. healthcare system for hip arthroscopy (HA). However, utilization of ASCs for HA remains low.

Abstract

Introduction

Hip arthroscopy (HA) is a minimally invasive procedure that has seen significant growth in its utilization. Ambulatory surgery centers (ASCs) have been shown to decrease costs while providing a quality of care comparable to that of outpatient hospitals (OHs); however, ASC cost savings and utilization for hip arthroscopy (HA) is unknown. This study characterizes 1) ASC utilization trends, 2) cost savings associated with ASCs for HA, and 3) effects of ASCs on patient out-of-pocket expenditures (POPE) and surgeon reimbursement (SR).

Methods

This retrospective cohort study utilized the U.S. 2013-2017 IBM MarketScan Commercial database to identify adult patients who underwent outpatient HA at OH or ASC. We identified three sub-cohorts: 1) isolated debridement, 2) femoral acetabular impingement (FAI) surgery, and 3) isolated labral repair. Immediate procedure reimbursement (IPR), POPE, and SR were calculated per patient. IPR for FAI surgery, the largest cohort, was subdivided into implant, anesthesia services, peripheral nerve block, operating room facility, SR, and other facility fees. A Cochran-Armitage Trend Test assessed ASC utilization trends over time. Multivariable modeling determined differences in IPR, POPE, and SR between ASCs and OHs.

Results

A total of 20,335 patients were identified with 3,739 in the debridement cohort, 14,583 in the FAI surgery cohort, and 2,013 in the labral repair cohort. From 2013-2017, ASC utilization for the full cohort increased by 5% but was only 32.1% in 2017; multivariable analysis found that ASCs significantly reduced IPR by $3310 (28.8%, p<0.01) and POPE by $47 (6.2%, p<0.01) with no significant reduction in SR. Analysis of cohorts revealed that increases in ASC utilization over the study period ranged from 4% in FAI surgery up to 12% in labral repair (p<0.05 for all cohorts). When IPR for FAI surgery was analyzed, ASCs saved costs on implants ($10, p=0.04), anesthesia services ($84, p<0.01), operating room facility ($940, p<0.01), and other facility fees ($2,577, p<0.01)

Conclusion

This study shows that ASC utilization for HA is increasing; however, absolute utilization is still low. A potential reason for low rates of ASC utilization could be surgeon comfort with performing HA in the ASC setting due to concern about complications and long procedural times, especially for FAI surgery. However, a 2019 study on 3,821 patients found no significant differences in complication rates for HA between the OH and ASC setting. This suggests significant room for improvement in utilization of ASCs as ASCs provide significant cost savings of $3310 per HA, and the bulk of these cost savings come from facility-related fees such as operating room facility fees. Furthermore, patient out-of-pocket expenditure is less when HA is performed at an ASC although patients are not realizing the majority of cost savings. In conclusion, this study demonstrates that ASCs effectively reduce the economic burden of HA by a significant amount on a per case basis but overall ASC utilization for HA remains low.