ASCs linked with decreased health care utilization, expenditures for ACL reconstruction
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Compared with outpatient hospitals, ASCs reduced total health care utilization and expenditures for ACL reconstruction in the United States from 2013 to 2017, according to published results.
Researchers from at the Icahn School of Medicine at Mount Sinai in New York analyzed total health care utilization, immediate procedure reimbursement and surgeon reimbursement from outpatient arthroscopic ACL reconstruction procedures from April 1, 2013, to June 30, 2017.
According to the study, 34,862 patients were included in the models for total health care utilization and immediate procedure reimbursement, while 33,881 patients were included in the model for surgeon reimbursement. Total health care utilization was defined as the sum of any payments related to the procedure from 90 days preoperatively to 180 days postoperatively.
Overall, 40.1% of patients (n = 13,990) had their ACL reconstruction performed in an ASC. Median total health care utilization was $17,363; median immediate procedure reimbursement was $12,042; and median surgeon reimbursement was $2,102. Multivariate analysis revealed outpatient hospital settings were associated with a $6,789 increase (39.1%) in total health care utilization compared with ASC settings, and out-of-network facilities were associated with a $6,719 increase (38.7%) in total health care utilization compared with in-network facilities.
Researchers noted outpatient hospital settings, out-of-network surgeons and facilities, and ACL reconstruction with additional meniscal repair or meniscectomy increased immediate procedure reimbursement and surgeon reimbursement. Having insurance other HMO increased total health care utilization and immediate procedure reimbursement; however, HMO had a minor effect on surgeon reimbursement, researchers noted.
“This study provides valuable insights into economic cost drivers of ACL reconstruction and shows that transitioning ACL reconstruction procedures to more cost-efficient ASCs has the potential to greatly reduce the economic burden on the U.S. health care system,” the researchers wrote in the study.