Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings.
JAMA Netw Open
; 3(10): e2015951, 2020 10 01.
Article
en En
| MEDLINE
| ID: mdl-33048128
ABSTRACT
Importance Surgical procedures can be performed in different settings, but the association between the operative setting and patient safety and cost to the patient and payer is unknown. Objective:
To examine differences in complications, total payments, and out-of-pocket (OOP) spending for minor hand surgical procedures performed in office, ambulatory surgery center (ASC), and hospital outpatient department (HOPD) operative settings. Design, Setting, andParticipants:
A retrospective, population-based cohort study was conducted using deidentified claims data from private employer-sponsored health insurance from January 1, 2009, to December 31, 2017. Patients aged 18 years or older undergoing carpal tunnel release, trigger finger release, excision of wrist ganglion, and excision of small hand masses (N = 468â¯365) were included. Exposures Operative setting, defined as procedures performed in the clinic setting, ASC, and HOPD. Main Outcomes andMeasures:
Complications during the 90-day postoperative period, total payments (total facility and payer reimbursement), and OOP spending.Results:
Of the 468â¯365 patients, 296â¯378 women (63.3%) and 171â¯987 men (36.7%) underwent minor hand surgical procedures from 2009 to 2017, with 284â¯889 procedures (60.8%) performed in HOPDs, 158â¯659 procedures (33.9%) performed in ASCs, and 24â¯817 procedures (5.3%) performed in the office setting. Ninety-day complications occurred in 3.4% of procedures performed in HOPDs, 3.3% in ASCs, and 2.9% in office settings (P < .001). After controlling for patient characteristics, procedures performed outside of the office had higher odds of complications (HOPDs odds ratio [OR], 1.32; 95% CI, 1.22-1.43; ASCs OR, 1.24; 95% CI, 1.14-1.34). Compared with the office setting, procedures performed in HOPDs incurred an extra $1216 in total payments (95% CI, $1184-$1248) and $115 in OOP expenses (95% CI, $109-$121). Procedures performed in ASCs cost an additional $709 (95% CI, $676-$741) and $140 in OOP expenses (95% CI, $134-$146). Transitioning ASC and HOPD procedures to the office setting could have saved an estimated $6 million annually in OOP expenses during the study period. Conclusions and Relevance The findings of this study suggest that minor hand surgery performed in the office setting is safe and less costly compared with ambulatory and hospital-based operations. Shifting minor surgical procedures to the office setting may lead to substantial cost savings for payers and patients without compromising care quality.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_financiamento_saude
Asunto principal:
Servicio de Cirugía en Hospital
/
Gastos en Salud
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Seguridad del Paciente
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Instituciones de Atención Ambulatoria
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Procedimientos Quirúrgicos Ambulatorios
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Mano
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Seguro de Salud
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
JAMA Netw Open
Año:
2020
Tipo del documento:
Article