Cost Comparison of Sports Medicine Procedures in Ambulatory Surgery Centers Versus Hospital Outpatient Departments for Medicare Recipients.

Background: Healthcare costs in the United States are rising in conjunction with an increased utilization of outpatient centers, particularly in sports medicine.

Purpose/hypothesis: The primary purpose of this study was to utilize Medicare data to compare the overall cost of sports medicine procedures performed in the ambulatory surgery centers (ASCs) and hospital outpatient department (HOPD) settings. The secondary purpose of this study was to compare facility fees, surgeon fees, Medicare payments, and patient payments between ASCs and HOPDs. It was hypothesized that procedures performed at ASCs would demonstrate a lower overall cost than those performed at HOPDs.

Study design: Cross-sectional study.

Methods: Publicly available data from the Centers for Medicare & Medicaid Services (CMS) were accessed via the Medicare Procedure Price Lookup Tool. Current Procedural Terminology (CPT) codes were used to identify sports medicine procedures approved for the outpatient setting by CMS. Facility fees, surgeon fees, total costs, Medicare payments, and patient payments were extracted. Descriptive statistics were utilized to calculate the mean and standard deviation for each category of fee and payment.

Results: A total of 62 CPT codes were identified. Compared with HOPDs, shoulder procedures (n = 25) at ASCs had lower total costs ($3622 ± $1160 vs $6261 ± $1759; P < .001), facility fees ($2777 ± $1020 vs $5416 ± $1606; P < .001), Medicare payments ($2898 ± $928 vs $5009 ± $1407; P < .001), and patient payments ($724 ± $232 vs $1252 ± $352; P < .001) compared with HOPDs. Knee procedures (n = 31) at ASCs had lower total costs ($4236 ± $2741 vs $6668 ± $3341; P = .006), facility fees ($3408 ± $2507 vs $5840 ± $3116; P = .006), Medicare payments ($3389 ± $2193 vs $5458 ± $2955; P = .006), and patient payments ($847 ± $548 vs $1209 ± $429; P = .011). Hip procedures (n = 6) at ASCs had lower total costs ($3583 ± $698 vs $6671± $1451; P = .025), facility fees ($2725 ± $669 vs $5813 ± $1431; P = .025), Medicare payments ($2866 ± $558 vs $5336 ± $1161; P = .025), and patient payments ($716 ± $139 vs $1333 ± $290; P = .025) compared with HOPDs.

Conclusion: Our study demonstrates that sports medicine procedures performed at ASCs for Medicare recipients result in considerable overall total cost savings when compared with those performed at HOPDs. Sports medicine providers should be aware of differences in costs when determining the best setting for these procedures.