Issue: January 2019
January 16, 2019
2 min read

Outpatient TSA yielded lower costs vs inpatient surgery

High-volume centers were 33% more expensive than the outpatient setting after excluding inpatient-specific charges.

Issue: January 2019
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CHICAGO — Results presented at the American Shoulder and Elbow Surgeons Annual Meeting showed significantly lower costs related to outpatient total shoulder arthroplasty when compared with inpatient total shoulder arthroplasty, even after excluding costs related directly to hospital accommodations.

“The way health care is now, we all have to be cognizant and understand that the choices we make as surgeons have impact on our patient’s finances and the finances of the health care system overall,” James M. Gregory, MD, in the department of orthopedic surgery at McGovern Medical School at UTHealth Science Center at Houston, told Orthopedics Today. “We should be good stewards of that money and try to do the best, most cost-effective care for our patients.”

Using a database provided by the Texas Department of Health and Human Services, Gregory and his colleagues identified all patients who underwent primary elective total shoulder arthroplasty (TSA) from 2010 to 2015. The procedures were separated into anatomic vs. reverse shoulder arthroplasty after 2011.

James M. Gregory, MD
James M. Gregory

“We had over 22,000 cases in over 300 hospitals and we defined a high-volume center as those performing over 15 cases per year,” Gregory said at the meeting.

Outpatient TSA constituted about 6.7% of the total volume, with no differences in the annual rate of volume increase between inpatient and outpatient settings. The rates of anatomic shoulder arthroplasty remained level, but there was a dramatic increase in the rate of reverse shoulder arthroplasty which “mirrored the rate of the rise in TSA overall,” he said.

“Looking at the costs ... procedure costs are relatively similar, but you can see dramatic differences in inpatient costs,” Gregory said. “Over $50,000 were expensed to perform the surgery in inpatient setting than outpatient setting.”

Patient level costs excluding inpatient charges

Results showed an increase in costs in all categories for inpatient shoulder arthroplasty. After excluding inpatient-specific charges, such as for accommodations, medications and nursing, Gregory said that inpatient surgery, overall, remained 41% more expensive than outpatient surgery.

“When we specifically looked at only high-volume centers — currently the gold standard for cost of regular care — it is still 33% more expensive than performing the same surgery in outpatient setting,” Gregory said.

Although this study looks at the cost of the resources that were used, the results do not show if “hospitals are earning $50,000 more because it does not directly relate to [reimbursement],” Gregory told Orthopedics Today.

Overall patient level costs

In the future, Gregory said it will be important to see if it matters where outpatient shoulder arthroplasty is performed and “whether doing outpatient shoulder arthroplasty in a hospital vs. an ambulatory surgery center has an effect on cost.” – by Casey Tingle

Disclosure: Gregory reports no relevant financial disclosures.