More Than Worth It: The Economic Impact of Shifting Soft Tissue Hand Procedures From the Operating Room to the Procedure Room.

Abstract

To inform value-driven efforts to improve adoption of procedure room (PR) hand surgery, we conducted a population-level comparative cost analysis of hand procedures performed in the PR versus operating room (OR) from the payer perspective. Using a national administrative database, we identified adult patients undergoing common soft tissue hand procedures. Patients were divided into cohorts based on site of service and anesthesia type (PR, OR without anesthesia, OR with anesthesia). Professional (surgeon, anesthesia) and facility reimbursements and total day-of-surgery and 90-day costs were compared. The cost savings from transitioning each procedure from the OR to the PR were calculated and used to model cumulative savings over 10 years from shifting 1000 cases per year to the PR. The difference in surgeon reimbursements for procedures performed in the PR compared with the OR with anesthesia ranged from +24.2% for DeQuervain release to +85.7% for endoscopic carpal tunnel release. The difference in surgeon reimbursements for procedures performed in the PR compared with the OR without anesthesia ranged from +9.8% for DeQuervain release to +75.3% for endoscopic carpal tunnel release. Large savings in day-of-surgery costs were achieved in the PR compared with the OR, driven by elimination of the facility fee. Projected cumulative 10-year cost savings for 1000 cases per year transitioned to the PR setting totaled over $20 million for OR cases with anesthesia and $13 million to $20 million for OR cases without anesthesia. Transitioning soft tissue hand procedures from the OR to the PR can result in large cost savings from the payer perspective.