The payments for similar knee and shoulder surgeries performed in ambulatory surgery centers were lower compared with hospital outpatient departments in many study states, according to a study released Thursday by the Workers Compensation Research Institute.
Researchers with the Cambridge, Massachusetts-based institute examined payments in 18 states in 2016, finding that in 14 of them payments for knee surgeries done at surgical centers were at least 21% lower than payments for hospital outpatient surgeries.
The authors examined payments to surgical centers and hospital outpatient departments by looking at the most common groups of surgeries conducted in outpatient settings — knee and shoulder arthroscopies, according to a summary of the study.
In three of the study states, the payments were similar, and in Indiana, payments for surgical center surgeries were 59% higher than payments for hospital outpatient surgeries, according to a summary of the findings.
In 11 of the study states, payments for shoulder surgeries done at surgical centers were at least 10% lower than payments for hospital outpatient surgeries in 2016, according to the findings.
Researchers attributed the differences in payments for surgical centers and hospital outpatient surgeries to multiple factors, such as a state’s fee schedule regulations, network participation rates, or negotiated prices.
An example cited, in Indiana payments for hospital outpatient surgeries are reimbursed at 200% of Medicare after the adoption of a hospital fee schedule for injured workers in 2014. Payments to surgical centers remain unregulated, according to a summary of the findings.
However, the study notes that changes in states’ fee schedules impacted the trends in surgical center payments for surgeries in a number of states. For example, in North Carolina, average payments for knee surgeries decreased 55% between 2012 and 2016. In New York, average payments for knee surgeries increased 50% between 2015 and 2016.
This article was first published by Business Insurance.
