Fahmy Joseph N, Kong Lingxuan, Wang Lu, Chung Kevin C
From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor MI.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor MI.
Ann Plast Surg. 2025 Jan 1;94(1):51-55. doi: 10.1097/SAP.0000000000004074. Epub 2024 Aug 6.
Policy impacting traditional Medicare beneficiaries may have unintended effects for privately insured patients. After the repeal of a longstanding $1500 outpatient therapy cap in 2018, we aimed to evaluate if this policy change was associated with differences in use of cost of postoperative therapy after common hand surgeries, including carpal tunnel release, trigger finger release, ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, and distal radius fracture open reduction/internal fixation or percutaneous pinning.
The Medicare Supplement and Coordination of Benefits files from Marketscan were used. Frequency of therapy appointments, overall costs, and out-of-pocket costs were obtained. A segmented interrupted time series with Poisson and log-transformed linear regression was performed.
No significant monthly change in odds of therapy use was found in the postpolicy period for patients who underwent trigger finger release, carpal tunnel release, Ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, or distal radius fracture, pinning, or open reduction/internal fixation. Overall cost decreased in the postpolicy period by 2% for comprehensive plans (95% confidence interval [CI]: -0.03 to -0.01, P < 0.001), by 7% for those with exclusive provider organizations (95% CI: -0.10 to -0.04, P < 0.001), by 1% for HMOs (95% CI: -0.01 to 0.002, P = 0.01), and by 3% for preferred provider organizations (95% CI: -0.03 to -0.02, P < 0.001). In the postpolicy period, no monthly change in out-of-pocket cost was observed for patients with comprehensive, exclusive provider organization, health maintenance organization, preferred provider organization, or point of service with capitation insurance plans.
Patients with employer-sponsored Medicare Advantage plans experienced increased out-of-pocket costs for therapy despite lower net costs. These data highlight an urgent need for policy ensuring that patients benefit when overall costs of care decrease.
影响传统医疗保险受益人的政策可能会对私人保险患者产生意想不到的影响。2018年一项长期实施的1500美元门诊治疗上限被废除后，我们旨在评估这一政策变化是否与常见手部手术后术后治疗费用使用的差异有关，这些手术包括腕管松解术、扳机指松解术、腱鞘囊肿切除术、桡骨茎突狭窄性腱鞘炎松解术、腕掌关节成形术以及桡骨远端骨折切开复位/内固定术或经皮穿针固定术。
使用了来自Marketscan的医疗保险补充和福利协调文件。获取了治疗预约频率、总费用和自付费用。进行了带有泊松分布和对数变换线性回归的分段中断时间序列分析。
对于接受扳机指松解术、腕管松解术、腱鞘囊肿切除术、桡骨茎突狭窄性腱鞘炎松解术、腕掌关节成形术或桡骨远端骨折、穿针固定术或切开复位/内固定术的患者，在政策实施后的时期内，未发现治疗使用几率有显著的月度变化。对于综合计划，政策实施后的时期内总费用下降了2%（95%置信区间[CI]：-0.03至-0.01，P<0.001）；对于独家供应商组织的患者，下降了7%（95%CI：-0.10至-0.04，P<0.001）；对于健康维护组织，下降了1%（95%CI：-0.01至0.002，P=0.01）；对于优选供应商组织，下降了3%（95%CI：-0.03至-0.02，P<0.001）。在政策实施后的时期内，对于综合、独家供应商组织、健康维护组织、优选供应商组织或按人头付费保险计划的服务点的患者，未观察到自付费用的月度变化。
尽管净成本较低，但参加雇主赞助的医疗保险优势计划的患者治疗的自付费用有所增加。这些数据凸显了迫切需要制定政策，以确保在医疗总费用降低时患者能够受益。
