WCRI FlashReport: Comparing Payments to Ambulatory Surgery Centers and Hospital Outpatient Departments

By Rebecca (Rui) Yang, Bogdan Savych

November 15, 2018 Related Topics: Ambulatory Surgery Centers

Some studies indicate that ambulatory surgery centers (ASCs) provide care that is less expensive than services provided in hospitals. This study compares payments for similar knee and shoulder surgeries performed on injured workers in ASCs with hospital outpatient departments. This analysis is important since evidence about ASC surgeries from other payors (Medicare or group health insurance) may not apply in workers’ compensation settings.

The authors examined payments to ASC and hospital outpatient departments by looking at the most common groups of surgeries conducted in outpatient settings—knee and shoulder arthroscopies. The study shows information on all payments to these two types of facilities (ASCs and hospital outpatient departments) within a surgical episode, excluding payments to surgeons or other medical professionals. 

The 18 states included in this study are California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin. These states were selected because they are geographically diverse; represent a range of system features; and represent the range of states that are higher, near the middle, and lower on costs per claim.

WCRI FlashReport: Comparing Payments to Ambulatory Surgery Centers and Hospital Outpatient Departments. Bogdan Savych and Rui Yang. November 2018. FR-18-03.

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Research Questions:

  • Were knee and shoulder surgeries performed in ASCs lower or higher when compared with hospital outpatient departments?
  • What factors may explain the differences in payments between ASC and hospital outpatient surgeries?
  • What are the overall trends in payments for surgeries performed in ASCs and hospital outpatient departments?

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