University of California, Berkeley, School of Public Health, 5423 Berkeley Way West Hall, Berkeley, CA 94720-7360. Email:
Am J Manag Care. 2024 Apr;30(4):179-184. doi: 10.37765/ajmc.2024.89529.
To quantify differences in prices paid and procedural complications incurred in hospital outpatient departments (HOPDs) and freestanding ambulatory surgery centers (ASCs).
Observational study using deidentified 2019-2020 insurance claims from Blue Cross Blue Shield insurance plans nationally, with information on prices paid and complications incurred for colonoscopy, knee or shoulder arthroscopy, and cataract removal surgery.
The data include 1,662,183 patients who received a colonoscopy, 53.5% of whom were treated in HOPDs; 259,200 patients who underwent arthroscopy, 61.0% of whom were treated in HOPDs; and 173,664 patients who had cataract removal surgery, 34.7% of whom were treated in HOPDs. Multivariable linear regression methods were used to identify the associations between HOPD and ASC site of care, prices, and complications after adjusting for patient demographics, risk, and geographic market location.
After adjusting for patient characteristics, risk, and geographic market location, prices paid in HOPDs were 54.9% higher than those charged in ASCs for colonoscopy (95% CI, 53.6%-56.1%), 44.4% higher for arthroscopy (95% CI, 43.0%-45.8%), and 44.0% higher for cataract removal surgery (95% CI, 42.9%-45.5%). Adjusted rates of complications were slightly higher in HOPDs than ASCs for colonoscopy over a 90-day interval but similar over the 7- and 30-day intervals. Rates were statistically and clinically similar between the 2 sites of care for arthroscopy and cataract removal.
The higher prices charged in HOPDs for the 3 ambulatory procedures were not balanced by better quality-as measured by rates of procedural complications-compared with procedures performed in nonhospital ASCs.
量化医院门诊部门（HOPD）和独立门诊手术中心（ASC）的价格差异和程序并发症。
使用全国范围内蓝十字蓝盾保险计划 2019-2020 年的匿名保险索赔进行观察性研究，提供结肠镜检查、膝关节或肩关节关节镜检查和白内障摘除手术的价格和并发症信息。
数据包括 1662183 名接受结肠镜检查的患者，其中 53.5%在 HOPD 接受治疗；259200 名接受关节镜手术的患者，其中 61.0%在 HOPD 接受治疗；173664 名接受白内障摘除手术的患者，其中 34.7%在 HOPD 接受治疗。使用多变量线性回归方法，在调整患者人口统计学、风险和地理位置后，确定 HOPD 和 ASC 护理地点、价格和并发症之间的关联。
在调整患者特征、风险和地理位置后，HOPD 收取的结肠镜检查价格比 ASC 高出 54.9%（95%置信区间，53.6%-56.1%），关节镜检查高出 44.4%（95%置信区间，43.0%-45.8%），白内障摘除手术高出 44.0%（95%置信区间，42.9%-45.5%）。在 90 天的间隔内，HOPD 的并发症调整率略高于 ASC，但在 7 天和 30 天的间隔内相似。在 2 个手术中心，关节镜检查和白内障摘除手术的并发症发生率在统计学和临床方面均相似。
与非医院 ASC 相比，3 种门诊手术在 HOPD 收取的更高价格并没有通过更好的质量来平衡——以程序并发症发生率衡量。
