Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY.
J Bone Joint Surg Am. 2021 Aug 4;103(15):1383-1391. doi: 10.2106/JBJS.20.01105.
As part of a market-driven response to the increasing costs of hospital-based surgical care, an increasing volume of orthopaedic procedures are being performed in ambulatory surgery centers (ASCs). The purpose of the present study was to identify recent trends in orthopaedic ASC procedure volume, utilization, and reimbursements in the Medicare system between 2012 and 2017.
This cross-sectional, national study tracked annual Medicare claims and payments and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates, and reimbursement rates, and to identify demographic predictors of ASC utilization.
A total of 1,914,905 orthopaedic procedures were performed at ASCs in the Medicare population between 2012 and 2017, with an 8.8% increase in annual procedure volume and a 10.5% increase in average reimbursements per case. ASC orthopaedic procedure utilization, including utilization across all subspecialties, is strongly associated with metropolitan areas compared with rural areas. In addition, orthopaedic procedure utilization, including for sports and hand procedures, was found to be significantly higher in wealthier counties (measured by average household income) and in counties located in the South.
This study demonstrated increasing orthopaedic ASC procedure volume in recent years, driven by increases in hand procedure volume. Medicare reimbursements per case have steadily risen and outpaced the rate of inflation over the study period. However, as orthopaedic practice overhead continues to increase, other Medicare expenditures such as hospital payments and operational and implant costs also must be evaluated. These findings may provide a source of information that can be used by orthopaedic surgeons, policy makers, investors, and other stakeholders to make informed decisions regarding the costs and benefits of the use of ASCs for orthopaedic procedures.
作为对医院基础外科护理成本不断增加的市场反应的一部分，越来越多的矫形手术正在日间手术中心（ASC）进行。本研究的目的是确定 2012 年至 2017 年期间 Medicare 系统中矫形 ASC 手术量、使用率和报销率的近期趋势。
本横断面全国性研究跟踪了 Medicare 的年度索赔和支付情况，并按县进行了汇总数据。采用描述性统计和多变量回归模型来评估手术量、使用率和报销率的趋势，并确定 ASC 使用率的人口统计学预测因素。
在 2012 年至 2017 年间， Medicare 人群中共有 1914905 例矫形手术在 ASC 进行，年手术量增长 8.8%，每例手术平均报销额增长 10.5%。与农村地区相比，ASC 矫形手术的使用率，包括所有亚专业的使用率，与大都市地区密切相关。此外，在较富裕的县（按家庭平均收入衡量）和南部县，发现包括运动和手部手术在内的矫形手术使用率明显更高。
本研究表明，近年来 ASC 矫形手术量不断增加，这主要是手部手术量的增加所致。每例 Medicare 报销金额稳步上升，在研究期间超过了通货膨胀率。然而，随着矫形手术的管理费用继续增加，还必须评估其他 Medicare 支出，如医院支付、运营和植入物成本。这些发现可能为整形外科医生、政策制定者、投资者和其他利益相关者提供有关 ASC 用于矫形手术的成本和效益的信息来源，以便他们做出明智的决策。
