The Increasing Financial Burden Of Out-of-Pocket Spending For Outpatient Surgical Procedures
*Jessica I Billig1, *Wen-Ching Lan2, *Yu-Ting Lu1, Kevin C Chung1, *Chang-Fu Kuo2, *Erika D Sears1
1Michigan Medicine, Ann Arbor, MI;2Chang Gung Memorial Hospital, Taoyuan, Taiwan
OBJECTIVE(S): Approximately 48 million outpatient surgeries are performed annually. However, little is known about the financial burden of outpatient surgery, specifically total expenditures and out-of-pocket (OOP) expenses. High levels of cost sharing may influence treatment decisions, delay care, and cause financial burden to patients.
METHODS: We conducted a retrospective cohort study of patients with employer-sponsored health insurance undergoing the most common outpatient surgical procedures (cholecystectomy, cataract, meniscectomy, muscle/tendon procedures, and joint procedures) using IBM MarketScan databases (2009-2017). Total payments for the surgical episode paid to the insurer and patient OOP expenses were calculated. We used multivariable linear regression to predict total payments and OOP expenses with costs inflation adjusted to 2017 dollars.
RESULTS: We evaluated 6,984,481 outpatient surgeries (2009-2017). Total payments increased by 33%, with a 68% increase in facility fees and 2% decrease in professional fees. OOP expenses grew by 65%. After controlling for procedure type, office-based procedures incurred $1,304 in predicted total payments (95%CI:$1,295-$1,315) and $223 in predicted OOP expenses (95%CI:$230-$227). Ambulatory procedures cost $3,217 in predicted total payments (95%CI:$3,205-$3,229) and $473 in predicted OOP expenses (95%CI:$469-$476), and hospital-based procedures cost $3,685 in predicted total payments (95%CI:$3,674-$3,697) and $426 in predicted OOP expenses (95%CI:$423-$429).
CONCLUSIONS: Increases in healthcare costs were driven primarily by facility fees and OOP expenses. OOP expenses are increasing at a faster rate than total payments, highlighting the transition in healthcare costs to patients. Given increased cost sharing, providers should consider modifiable cost drivers including operative setting to minimize financial burden for patients when feasible.
Back to 2020 Abstracts