Nearly 53 million outpatient procedures are performed annually in the United States. While most of these procedures occur in hospital outpatient departments, a growing number are being done in nonhospital-based facilities such as ambulatory surgery centers and physician offices.
A new study encourages providing outpatient surgery in these less-resource-intensive settings. It found that urological surgery (except for two procedure groups) performed in ambulatory surgery centers and physician offices was associated with lower overall episode payments than hospitals. Average total payments for outpatient surgery episodes varied widely, from $200 for urethral dilation at a physician office to $5,688 for shock wave lithotripsy at a hospital. Compared to hospitals, office-based prostate biopsies were nearly 75 percent less costly.
The biggest driver of payment differences among hospitals, ambulatory surgery centers, and physician offices was outpatient facility payment. For example, outpatient facility payments accounted for 88 percent of the 30-day payments following shock wave lithotripsy at a hospital.
The researchers used national Medicare claims data to examine episode payments for 22 common outpatient urological procedures between 1998 and 2006. The study was not able to assess the impact of the Centers for Medicare & Medicaid rule beginning in 2008 that mandated reimbursement of facility fees for ambulatory surgery centers at two-thirds the rate of hospitals. The study was supported by AHRQ (HS18726).
See "Medicare payments for outpatient urological surgery by location of care," by John M. Hollingsworth, M.D., Chris S. Saigal, M.D., M.P.H., Julie C. Lai, M.P.H., and others in the Journal of Urology 188, pp. 2323-2327, 2012.