Outpatient spinal treatments are becoming more common, with an increasing number performed in ambulatory surgical facilities (ASCs). For this study, the authors used the Healthcare Cost and Utilization Project’s (HCUP) Florida State Ambulatory Surgery Database (SASD) for 2013 and 2014. Patients getting outpatient lumbar decompression for degenerative diseases were identified using CPT (Current Procedural Terminology) and ICD-9 codes.
There were a total of 25,486 patients identified, with 7067 (27.7%) undergoing lumbar decompression in a standalone ASC and 18,419 (72.3%) in a HO. For patients on Medicare or Medicaid (mean index admission charge increase $4049.27, 95% CI $2577.87–$5520.67, p < 0.001), and for patients with private insurance ($4775.72, 95% CI $4171.06–$5380.38, p < 0.001), ASC operations were linked with higher charges than HO procedures. A lumbar decompression treatment at an ASC was linked with a decrease in index admission charge of $10,995.38 (95% CI −$12124.76 to −$9866.01, p < 0.001) compared to a lumbar decompression surgery at a HO for patients on self-pay or no fee.
These findings from a statewide database of all payers suggest that ASCs are related to higher index admissions and subsequent 7-, 30-, and 90-day costs for outpatient spine surgery. Given that ASCs have lower total costs for patients and higher profit margins for doctors, these studies call for more research to see if this cost-benefit applies to outpatient spine treatments.