Ambulatory Surgery Centers Significantly Decrease Total Health Care Expenditures in Primary Anterior Cruciate...

Area of Science:

• Orthopaedic Surgery
• Health Economics
• Epidemiology

Background:

• Anterior cruciate ligament reconstruction (ACLR) is a frequent orthopedic procedure with rising annual costs.
• The specific factors driving these increasing healthcare expenditures for ACLR are not well understood.

Purpose of the Study:

• To identify modifiable factors influencing total healthcare utilization (THU), immediate procedure reimbursement, and surgeon reimbursement for ACLR patients.
• Utilizing a national commercial insurance database from 2013-2017 to analyze cost drivers.

Main Methods:

• Descriptive epidemiological study analyzing data from the MarketScan Commercial Claims and Encounters database (2013-2017).
• Included patients undergoing arthroscopic ACLR (CPT code 29888).
• THU was calculated from 90 days pre- to 180 days post-procedure; multivariable models assessed cost drivers.

Main Results:

• Outpatient hospital setting significantly increased THU and immediate reimbursement (+$6,789).
• Out-of-network surgeons increased surgeon reimbursement (+$1,337).
• Health maintenance organizations decreased THU and reimbursements compared to preferred provider organizations (P < .05).

Conclusions:

• Utilizing ambulatory surgery centers is the most effective strategy for reducing ACLR healthcare costs.
• Health maintenance organizations offer some cost-optimization benefits but have a limited impact on surgeon reimbursement.
• This research enhances understanding of ACLR cost drivers and provides a basis for future cost-reduction strategies.