The Effect of Moving Carpal Tunnel Releases Out of Hospitals on Reducing United States Health Care Charges

Abstract

Purpose To better understand how perioperative care impacts charges for carpal tunnel release (CTR). Methods We developed a cohort using ICD9-DM procedure code 04.43 for CTR in the National Survey of Ambulatory Surgery 2006 to test perioperative factors potentially associated with CTR costs. We examined factors that might impact costs including: patient characteristics, payor, surgical time, setting (hospital outpatient department “HOPD” vs. freestanding ambulatory surgery center “ASC”), anesthesia type, anesthesia provider, discharge status, and adverse events. Records were grouped by facility to reduce the impact of surgeon and patient heterogeneity. Facilities were divided into quintiles based on average total facility charges per CTR. This division allowed comparison of factors associated with the lowest and highest quintile of facilities based on average charge per CTR. Results 160,000 CTRs were performed in 2006. Nearly all patients were discharged home without adverse events. Mean charge across facilities was $2572 (SD $2331 to $2813). Patient complexity and intra-operative duration of surgery was similar across quintiles (approximately 13 minutes). Anesthesia techniques were not significantly associated with patient complexity, charges, and total perioperative time. HOPD setting was strongly associated with total charges, with $500 higher charge per CTR. Half of all CTRs were performed in HOPDs. Facilities in the lowest quintile charge group were ASCs. Conclusions Examination of charges for CTR suggests that surgical setting is a large cost driver with the potential opportunity to lower charges for CTRs by approximately 30% if performed in ASCs. Type of Study Economic and Decision Analysis Level of Evidence Level II Retrospective Study

Cost Implications of Varying the Surgical Setting and Anesthesia Type for Trigger Finger Release Surgery

“…Nonetheless, it has been previously established that the hospital-based OR setting is significantly more expensive than an ambulatory surgery setting for carpal tunnel release surgery. 17,22 We believe that excluding this costlier surgical setting does not curtail the goal of the current investigation, which is to highlight opportunities for cost-savings for TFR surgery. We are unable to comment on costs associated with TFR treatment strategies beyond those performed at our institution.…”

Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings

“…Moreover, in a Downloaded From: https://jamanetwork.com/ on 10/31/2020 Downloaded From: https://jamanetwork.com/ on 10/31/2020 national study of carpal tunnel releases, the largest contributor to greater charges was operative setting, with HOPDs associated with a $500 higher charge than ASCs. 23 However, the office setting was not included in this analysis. In our study, only 5.3% of minor procedures were performed in the office setting, but these office-based procedures were significantly less costly than those performed in other operative settings, highlighting the underuse of the office as an operative setting.…”

Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

“…Surgery performed at ASCs is less expensive for insurers than surgery performed at HOPDs. 19,20 In 2014, the national average Medicare facility payment rate for cataract removal was $976 at an ASC and $1766 at an HOPD. 21 One analysis estimated that cataract surgeries performed at ASCs rather than HOPDs saved Medicare $829 million in 2011.…”