In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States

Abstract

BackgroundThe purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VSI]) can provide for improved diagnostic assessment and; more cost effective care.MethodsData on arthroscopy procedures in the US for deep seated pathology in the knee and shoulder were used (Calendar Year 2012). These procedures represent approximately 25-30% of all arthroscopic procedures performed annually. Sensitivities, specificities, positive predictive, and negative predictive values for MRI analysis of this deep seated pathology from systematic reviews and meta-analyses were used in assessing for false positive and false negative MRI findings. The costs of performing diagnostic and surgical arthroscopy procedures (using 2013 Medicare reimbursement amounts); costs associated with false negative findings; and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were then assessed.ResultsIn patients presenting with medial meniscal pathology (ICD9CM diagnosis 836.0 over 540,000 procedures in CY 2012); use of the VSI system in place of MRI assessment (standard of care) resulted in a net cost savings to the system of $151 million. In patients presenting with rotator cuff pathology (ICD9CM 840.4 over 165,000 procedures in CY2012); use of VSI in place of MRI similarly saved $59 million. These savings were realized along with more appropriate care as; fewer patients were exposed to higher risk surgical arthroscopic procedures.ConclusionsThe use of an in-office arthroscopy system can: possibly save the US healthcare system money; shorten the diagnostic odyssey for patients; potentially better prepare clinicians for arthroscopic surgery (when needed) and; eliminate unnecessary outpatient arthroscopy procedures, which commonly result in surgical intervention.

Evaluation of the caudal cervical articular process joints by using a needle arthroscope in standing horses

“…Needle arthroscopy is an expanding technique in both human and veterinary surgery. 12 The literature in which the use of needle arthroscopy in horses is described is still limited; however, many surgical facilities are already performing elective needle arthroscopic procedures in both standing and anesthetized horses. Its minimal morbidity, portability of equipment and applicability in the standing patient makes this equipment advantageous in an equine surgical facility.…”

“…The procedure is performed by using a high definition camera attached to a 0° to 10° angle semirigid arthroscope of 1.2‐mm diameter (18‐gauge needle equivalent) and 65‐ or 100‐mm length that connects to a tablet screen. Benefits compared with conventional arthroscopy include the portability of the equipment, the ability to perform the procedure with the horse standing, and the minimal morbidity because of the small‐diameter arthroscopic portal, ultimately reducing recovery time . Previous descriptions of needle arthroscopy performed in horses have been limited to the stifle joint and the navicular bursa .…”

“…Previous descriptions of needle arthroscopy performed in horses have been limited to the stifle joint and the navicular bursa . The technique is increasingly used in humans undergoing minimally invasive orthopedic procedures and has the potential to be useful in all routine equine arthroscopic procedures.…”

“…Benefits compared with conventional arthroscopy include the portability of the equipment, the ability to perform the procedure with the horse standing, and the minimal morbidity because of the small-diameter arthroscopic portal, ultimately reducing recovery time. [12][13][14] Previous descriptions of needle arthroscopy performed in horses have been limited to the stifle joint and the navicular bursa. 11,15 The technique is increasingly used in humans undergoing minimally invasive orthopedic procedures [12][13][14] and has the potential to be useful in all routine equine arthroscopic procedures.…”

Medical arthroscopy: A tool for diagnosis and research in rheumatology

“…One major advantage of office‐based needle arthroscopy is its cost effectiveness as it does not entail a formal operating room. For certain deep‐seated conditions of the knee and shoulder like medial meniscal and rotator cuff pathology, where magnetic resonance imaging (MRI) may show false positive results, in turn leading to unnecessary surgical exploration, the use of office arthroscopy in place of MRI assessment can result in significant net cost savings …”