Medicare Trends In Ambulatory Surgery

Leader, Shelah; Moon, Marilyn

doi:10.1377/hlthaff.8.1.158

Cited by 36 publications

(14 citation statements)

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“…1,2 Two reasons are commonly quoted as underlying this trend: (1) advances in medical techniques making procedures safer (ie, minimally invasive approaches and advances in anesthesia techniques), 9,10 and (2) changes in the payment structure favoring the shift of less complex cases to an outpatient basis. 11 Cullen et al 1 reported that the overall increase in the ambulatory surgery volume was primarily due to an increase in procedures being performed in freestanding facilities. This finding is in concordance with our results, which showed an approximately 300% rise of procedures performed in this setting.…”

Section: Discussionmentioning

confidence: 99%

Changes in Anesthesia-Related Factors in Ambulatory Knee and Shoulder Surgery

Memtsoudis

Kuo²,

et al. 2011

Regional Anesthesia and Pain Medicine

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Background Analyses of existing nationally representative information on how changes in ambulatory orthopedic surgery have affected anesthesia practice over time are rare. We sought to characterize temporal changes in factors surrounding ambulatory orthopedic surgery and anesthesia. Methods Data from the National Survey of Ambulatory Surgery for the years of 1996 and 2006 were analyzed. Entries indicating the performance of knee ligamentoplasty, meniscectomy or shoulder arthroscopy were identified and included in the sample. Temporal changes in a number of variables associated with orthopedic ambulatory surgery were assessed, including: 1) the number of procedures being performed, 2) patient and health care system related demographics and 3) anesthesia related variables. Results Nationwide, the total number of ligamentoplasties, meniscectomies and shoulder arthroscopies increased from 1996 to 2006 by 66% (N=258,932 to N=428,712), 51% (N=456,698 to N=690,164), and 349% (N=93,105 to N=418,188) respectively (P<0.0001). Between 1996 and 2006 the use of peripheral nerve blocks increased from 0.6% to 9.8% for meniscectomies (P<0.0001), from 1.5% to 13.7% for ligamentoplasties (P<0.0001), and from 11.5% to 23.9% for shoulder arthroscopies (P<0.0001), respectively. Neuraxial anesthesia utilization fell from 11.8% to 6.3% for meniscectomies (P<0.0001) and 13.6% to 7.3% for ligamentoplasties (P<0.0001) from 1996 to 2006, respectively. Conclusion Substantial increases in the number of ambulatory knee and shoulder procedures occurred over time, relating to increased demand for anesthesia providers in this field. Trends towards increased use of peripheral nerve blocks may have to be considered by educators when preparing residents for practice.

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Section: Discussionmentioning

confidence: 99%

Changes in Anesthesia-Related Factors in Ambulatory Knee and Shoulder Surgery

Memtsoudis

Kuo²,

et al. 2011

Regional Anesthesia and Pain Medicine

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“…Among the reasons commonly attributed to this development are changes in the payment structure favoring the shift of less complex cases to an outpatient basis [4]. However, the cost-effectiveness of ambulatory surgeries depends largely on the ability to discharge patients to their customary residence on the same day that the procedure is performed.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing unexpected disposition after orthopedic ambulatory surgery

Memtsoudis¹,

Ma²,

Swamidoss³

et al. 2012

Journal of Clinical Anesthesia

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Study Objective To analyze whether patient characteristics, ambulatory facility type, anesthesia provider and technique, procedure type, and temporal factors impact the outcome of unexpected disposition after ambulatory knee and shoulder surgery. Design Retrospective analysis of a national database. Setting Freestanding and hospital-based ambulatory surgery facilities. Measurements Ambulatory knee and shoulder surgery cases from 1996 and 2006 were identified through the National Survey of Ambulatory Surgery. The incidence of unexpected disposition status was determined and risk factors for such outcome were analyzed. Main Results Factors independently increasing the risk for unexpected disposition included procedures performed in hospital-based versus freestanding facilities [odds ratio (OR) 6.83 (95% confidence interval [CI] 4.34; 10.75)], shoulder versus knee procedures [OR 3.84 (CI 2.55; 5.77)], anesthesia provided by nonanesthesiology professionals and certified registered nurse-anesthetists versus anesthesiologists [OR 7.33 (CI 4.18; 12.84) and OR 1.80 (CI 1.09; 2.99), respectively]. Decreased risk for unexpected disposition were found for procedures performed in 2006 versus 1996 [OR 0.15 (CI 0.10; 0.24)] and the use of anesthesia other than regional and general [OR 0.34 (CI 0.18; 0.68)]. Conclusions The decreased risk for unexpected disposition associated with more recent data and with freestanding versus hospital-based facilities may represent improvements in efficiency, while the decreased odds for such disposition status associated with the use of other than general and regional anesthesia may be related to a lower invasiveness of cases. We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. No difference in this outcome was noted when an anesthesia care team provided care.

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“…During this time, healthcare reform and the development of prospective payment systems created strong financial incentives for the transition to ambulatory surgical centers (56), which were further enhanced by the growth of managed care and hospital consolidation (57,58). In an era of increasing healthcare costs and a purported surgeon shortage (59), there has been a drive toward cost containment, leading to the development of "fast track surgery" for ambulatory procedures (60).…”

Section: Discussionmentioning

confidence: 99%