Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings.
Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings.
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DOI：
10.1001/jamanetworkopen.2020.15951
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Sears ED
中科院分区：
文献类型：
--
作者：
Billig JI;Nasser JS;Chen JS;Lu YT;Chung KC;Kuo CF;Sears ED
在不同的手术环境下进行的手部小手术的并发症、总费用和自付费用有哪些？在这项以人群为基础的队列研究中，468例 365例小手外科手术中，3.4%的手术在医院门诊部进行，3.3%在门诊手术中心进行，2.9%在办公室进行。然而，门诊和基于医院的手术对支付者和患者来说明显更昂贵。这项研究的结果表明，将小的手部手术过渡到办公室可能会减少支付者和患者的支出，而不会影响术后结果。手术过程可以在不同的环境中进行，但手术环境与患者安全和患者和付款人的成本之间的关联尚不清楚。研究在办公室、门诊手术中心(ASC)和医院门诊部(HOPD)手术环境中进行的小手部外科手术的并发症、总费用和自付费用(OOP)方面的差异。一项基于人群的回溯性队列研究使用了从2009年1月1日至2017年12月31日私人雇主赞助的医疗保险的已确定索赔数据。18岁或以上的患者接受腕管松解、扳机指松解、腕神经节切除和手部小肿块切除(N = 468 365)。手术环境，定义为在临床环境、ASC和HOPD中执行的程序。术后90天期间的并发症、总支付额(总设施和支付方报销)和OOP费用。在468名 365患者中，296名 378名女性(63.3%)和171名 987名男性(36.7%)在2009年至2017年期间接受了手部小手术，其中284例 889例(60.8%)在家庭护理中心进行，158例 659例(33.9%)在ASCs进行，24例 817例(5.3%)在办公室进行。90天并发症的发生率分别为3.4%、3.3%和2.9%(P <； .001)。在控制了患者特征后，在办公室外进行手术的并发症的风险更高(HOPD：优势比[OR]，1.32；95%CI，1.22-1.43；ASCS：OR，1.24；95%CI，1.14-1.34)。与办公室环境相比，在HOPD中进行的程序产生了1216美元的总支付(95%CI，1184-1248美元)和115美元的OOP费用(95%CI，109-121美元)。在ASCs中进行的手术额外花费709美元(95%CI，676-741美元)和140美元的OOP费用(95%CI，134-146美元)。在研究期间，将ASC和HOPD程序过渡到办公室环境可以每年节省约600万美元的OOP费用。这项研究的结果表明，与门诊和医院手术相比，在办公室环境下进行的手部小手术是安全的，而且成本更低。将小手术转移到办公室可能会在不影响护理质量的情况下为支付者和患者节省大量成本。这项队列研究考察了医院门诊部、门诊外科中心和小型手部外科手术的办公室环境之间的成本差异。
What are the complications, total payments, and out-of-pocket expenses associated with minor hand surgical procedures performed in different operative settings? In this population-based cohort study of 468 365 minor hand surgical procedures, complications occurred in 3.4% of procedures performed in hospital outpatient departments, 3.3% in ambulatory surgery centers, and 2.9% in office settings. However, ambulatory and hospital-based procedures were significantly more expensive for payers and patients. The findings of this study suggest that transitioning minor hand procedures to the office may reduce spending for payers and patients without compromising postoperative outcomes. 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. 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. 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 = 468 365) were included. Operative setting, defined as procedures performed in the clinic setting, ASC, and HOPD. Complications during the 90-day postoperative period, total payments (total facility and payer reimbursement), and OOP spending. Of the 468 365 patients, 296 378 women (63.3%) and 171 987 men (36.7%) underwent minor hand surgical procedures from 2009 to 2017, with 284 889 procedures (60.8%) performed in HOPDs, 158 659 procedures (33.9%) performed in ASCs, and 24 817 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. 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. This cohort study examines the differences in cost among hospital outpatient departments, ambulatory surgery centers, and office settings for minor hand surgical procedures.
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