McCormick Johnathon R, Harkin William E, Federico Vincent P, Morgan Vince K, Browning Robert B, Salazar Luis M, Jackson Garrett R, Khan Zeeshan A, Kaplan Daniel J, Verma Nikhil N, Cole Brian J, Chahla Jorge
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2025 Aug 29;13(8):23259671251333110. doi: 10.1177/23259671251333110. eCollection 2025 Aug.
Healthcare costs in the United States are rising in conjunction with an increased utilization of outpatient centers, particularly in sports medicine.
PURPOSE/HYPOTHESIS: The primary purpose of this study was to utilize Medicare data to compare the overall cost of sports medicine procedures performed in the ambulatory surgery centers (ASCs) and hospital outpatient department (HOPD) settings. The secondary purpose of this study was to compare facility fees, surgeon fees, Medicare payments, and patient payments between ASCs and HOPDs. It was hypothesized that procedures performed at ASCs would demonstrate a lower overall cost than those performed at HOPDs.
Cross-sectional study.
Publicly available data from the Centers for Medicare & Medicaid Services (CMS) were accessed via the Medicare Procedure Price Lookup Tool. Current Procedural Terminology (CPT) codes were used to identify sports medicine procedures approved for the outpatient setting by CMS. Facility fees, surgeon fees, total costs, Medicare payments, and patient payments were extracted. Descriptive statistics were utilized to calculate the mean and standard deviation for each category of fee and payment.
A total of 62 CPT codes were identified. Compared with HOPDs, shoulder procedures (n = 25) at ASCs had lower total costs ($3622 ± $1160 vs $6261 ± $1759; < .001), facility fees ($2777 ± $1020 vs $5416 ± $1606; < .001), Medicare payments ($2898 ± $928 vs $5009 ± $1407; < .001), and patient payments ($724 ± $232 vs $1252 ± $352; < .001) compared with HOPDs. Knee procedures (n = 31) at ASCs had lower total costs ($4236 ± $2741 vs $6668 ± $3341; = .006), facility fees ($3408 ± $2507 vs $5840 ± $3116; = .006), Medicare payments ($3389 ± $2193 vs $5458 ± $2955; = .006), and patient payments ($847 ± $548 vs $1209 ± $429; = .011). Hip procedures (n = 6) at ASCs had lower total costs ($3583 ± $698 vs $6671± $1451; = .025), facility fees ($2725 ± $669 vs $5813 ± $1431; = .025), Medicare payments ($2866 ± $558 vs $5336 ± $1161; = .025), and patient payments ($716 ± $139 vs $1333 ± $290; = .025) compared with HOPDs.
Our study demonstrates that sports medicine procedures performed at ASCs for Medicare recipients result in considerable overall total cost savings when compared with those performed at HOPDs. Sports medicine providers should be aware of differences in costs when determining the best setting for these procedures.
美国的医疗保健成本随着门诊中心利用率的提高而上升，尤其是在运动医学领域。
目的/假设：本研究的主要目的是利用医疗保险数据，比较在门诊手术中心（ASC）和医院门诊部（HOPD）进行的运动医学手术的总体成本。本研究的次要目的是比较ASC和HOPD之间的设施费用、外科医生费用、医疗保险支付和患者支付。假设在ASC进行的手术将显示出比在HOPD进行的手术更低的总体成本。
横断面研究。
通过医疗保险程序价格查询工具访问医疗保险和医疗补助服务中心（CMS）公开的数据。使用当前程序编码术语（CPT）代码来识别CMS批准的门诊环境下的运动医学手术。提取设施费用、外科医生费用、总成本、医疗保险支付和患者支付。使用描述性统计来计算每个费用和支付类别的平均值和标准差。
共识别出62个CPT代码。与HOPD相比，ASC的肩部手术（n = 25）总成本更低（3622美元±1160美元对6261美元±1759美元；P <.001），设施费用更低（2777美元±1020美元对5416美元±1606美元；P <.001），医疗保险支付更低（2898美元±928美元对5009美元±1407美元；P <.001），患者支付更低（724美元±232美元对1252美元±352美元；P <.001）。ASC的膝关节手术（n = 31）总成本更低（4236美元±2741美元对6668美元±3341美元；P =.006），设施费用更低（3408美元±2507美元对5840美元±3116美元；P =.006），医疗保险支付更低（3389美元±2193美元对5458美元±2955美元；P =.006），患者支付更低（847美元±548美元对1209美元±
