According to research recently published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), direct costs for select orthopaedic procedures were significantly less when these procedures were performed at an ambulatory surgical center (ASC) rather than at a university-based children's hospital (UH).

The study authors looked at the direct costs of 1,021 surgical bone and joint procedures in which patients were able to choose whether their procedures were performed at an ASC or a UH. Direct costs, as defined in the study, are goods and services such as drugs, implants, and laboratory and radiological services. All procedures were performed by the same group of orthopaedic surgeons. Patients who required an overnight stay (eg, revision surgeries, complex cases, medically complex patients) were excluded. Outcomes of the surgical bone and joint procedures were not reviewed.

"There was a savings in direct costs of 17 percent to 43 percent, depending on the procedure, when performed at an ASC rather than at a UH," said Peter D. Fabricant, MD, MPH, of the Hospital for Special Surgery and lead author of the study performed at Children's Hospital of Philadelphia. The savings (Fig. 1) appear to be the result of more efficient usage of time and resources due to streamlined care processes at the ASC, compared to those at the UH, for the same bone and joint procedure, explained Dr. Fabricant.

According to the investigators, potential patient benefits of receiving select surgical bone and joint care at ASCs include a decrease in the overall cost of health care with a more efficient care model that could help insurance premiums and copayments remain steady or decrease. In addition, clinically eligible patients and families would have the ability to choose the surgical location most convenient for them.

"If orthopaedic practices gained access to an ASC for day surgery, they would be able to deliver the same care at a decreased cost and improve patient satisfaction by offering the convenience of care location options," asserted Dr. Fabricant. "From the patient and family perspective, care closer to one's home and family is of higher value. Hospital systems have started to respond by shifting resources into developing satellite centers."

The research suggests ASCs can be convenient and potentially offer some cost savings to both insurers and patients. However, patients with medically complex conditions are not eligible candidates for care in a satellite setting. The ASC in this study offered services/care performed close to people's homes—which may not be available in all regions or practice settings—and requires less operational overhead than a UH often located in an urban setting.

Additional Information:
Cost Savings From Utilization of an Ambulatory Surgery Center for Orthopaedic Day Surgery