Immediate Procedure Reimbursement, 30-Day and 90-Day Episode Payments are Lower in Ambulatory Surgery Centers Versus Hospital Outpatient Departments for Lumbar Laminectomy.

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-08-04 DOI:10.1097/BSD.0000000000001890

Justin Tiao, Mayuri Jain, Ryan Hoang, Alexander Yu, Jonathan J Huang, Andrew C Hecht, Brocha Z Stern, Saad Chaudhary

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引用次数: 0

Abstract

Study design: Retrospective cohort study.

Objective: The primary objective was to compare the immediate procedure reimbursement between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) for single-level and multilevel lumbar laminectomies in commercially insured patients. The secondary objectives were to compare (1) patient out-of-pocket expenditures and surgeon-specific reimbursement and (2) 30-day and 90-day episode payments between the surgery settings.

Summary of background data: Lumbar laminectomy is a common treatment for lumbar spine pathology, with cases increasing annually in outpatient settings. However, there is no clear consensus on financial savings related to ASCs versus HOPDs for these procedures.

Methods: The Merative MarketScan Commercial Claims and Encounters Database identified lumbar laminectomies performed at an ASC or HOPD in patients aged 18-64. Immediate procedure reimbursement, surgeon reimbursement, and 30-day and 90-day payments were constructed from gross payments; corresponding patient out-of-pocket expenditures were extracted. Multivariable regression models estimated adjusted between-setting mean differences and 95% confidence intervals.

Results: After matching, the single-level cohort included 699 patients (36.9% ASCs), and the multilevel cohort included 694 patients (36.0% ASCs). In multivariable models, the adjusted mean of immediate procedure reimbursement was lower for ASCs (single-level: -$2492, P=0.001; multilevel: -$5629, P<0.001). Surgeon reimbursement was higher for single-level procedures in ASCs ($911, P<0.001). Payments were lower for ASCs in the 30-day period (single-level: -$4354, P<0.001; multilevel: -$7781, P<0.001) and 90-day period (single-level: -$3757, P<0.001; multilevel: -$8465, P<0.001).

Conclusions: Immediate procedure reimbursement, 30-day and 90-day payments were lower for ASCs versus HOPDs. Surgeon reimbursement was higher in ASCs for single-level while no difference was observed for multilevel procedures. These findings highlight the potential for savings from performing lumbar laminectomies in ASCs versus HOPDs for commercially insured patients.

Level of evidence: Level III.

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对于腰椎椎板切除术，门诊手术中心的即时手术报销、30天和90天的治疗费用低于医院门诊。

研究设计：回顾性队列研究。目的：主要目的是比较门诊手术中心（ASCs）和医院门诊部（HOPDs）对商业保险患者单节段和多节段腰椎板切除术的即时手术报销情况。次要目的是比较(1)患者自付费用和外科特定报销；(2)手术设置之间30天和90天的插曲付款。背景资料总结：腰椎椎板切除术是腰椎病理的常用治疗方法，门诊病例每年都在增加。然而，对于ASCs和hopd在这些手术中节省的资金并没有明确的共识。方法：Merative MarketScan商业索赔和遭遇数据库确定了18-64岁患者在ASC或HOPD进行腰椎椎板切除术。即刻手术报销、外科医生报销、30天和90天的付款由总付款构成；提取相应的患者自付费用。多变量回归模型估计调整后的设定间均值差异和95%置信区间。结果：匹配后，单水平队列纳入699例患者（36.9% ASCs），多水平队列纳入694例患者（36.0% ASCs）。在多变量模型中，ASCs的即时手术报销调整后的平均值较低(单水平：- 2492美元，P=0.001；结论：与hopd相比，ASCs的即时手术报销、30天和90天付款较低。单节段ASCs的外科医生报销较高，而多节段ASCs的外科医生报销无差异。这些发现强调了ASCs与商业保险患者的hopd相比，行腰椎椎板切除术的潜力。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.