Prices and complications in hospital-based and freestanding surgery centers.

Area of Science:

• Health Economics
• Surgical Outcomes
• Healthcare Policy

Background:

• Ambulatory surgery is increasingly performed in both hospital outpatient departments (HOPDs) and freestanding ambulatory surgery centers (ASCs).
• Understanding cost and quality variations between these care settings is crucial for healthcare policy and patient decision-making.

Purpose of the Study:

• To quantify differences in prices paid and procedural complications for common ambulatory surgeries performed in HOPDs versus ASCs.
• To compare the cost-effectiveness of care delivery across different surgical settings.

Main Methods:

• An observational study analyzed deidentified national insurance claims (2019-2020) from Blue Cross Blue Shield.
• Data included prices and complications for colonoscopy, arthroscopy, and cataract removal surgeries.
• Multivariable regression adjusted for patient and market factors to compare HOPD and ASC outcomes.

Main Results:

• Prices were substantially higher in HOPDs: 54.9% for colonoscopy, 44.4% for arthroscopy, and 44.0% for cataract surgery.
• Complication rates were similar between HOPDs and ASCs for arthroscopy and cataract removal.
• Slightly higher complication rates were observed in HOPDs for colonoscopy over 90 days, but not at 7 or 30 days.

Conclusions:

• Higher prices in HOPDs for these ambulatory procedures were not associated with improved quality or reduced complication rates compared to ASCs.
• This suggests potential for cost savings by shifting care to ASCs without compromising patient safety for these procedures.