MANAGED CARE March 2010. ©MediMedia USA
Nearly 60 percent of all surgical procedures take place in an ambulatory setting, where the patient receives less than 24 hours of hospital care, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). That’s good news to health plans, considering that the mean charge for ambulatory surgery is lower than for inpatient surgery — $6,100 versus $39,900. (Bold intended!) The study collected data from 28 states.
There are two factors that might explain the overall growth in ambulatory surgeries. First, surgery has become easier with advances in surgical technology and anesthesia. Second, health care payment policies encourage ambulatory surgery. For example, Medicare adopted an outpatient payment system authorizing payment for surgical services in a variety of settings, such as a physician’s office, a hospital outpatient department, or an ambulatory surgical center.
| Characteristics of outpatient and inpatient surgeries | ||
|---|---|---|
| Characteristics | Ambulatory surgeries | Inpatient surgeries |
| Total visits/stays for surgeries (percentage of all surgical encounters) | 10.8 million (57.7%) | 7.9 million (42.3%) |
| Visits/stays per 100,000 population | 5,600 | 4,100 |
| Total number of surgeries (percentage of all surgical procedures) | 12.4 million (53.0%) | 11.0 million (47.0%) |
| Average number of surgeries per visit/stay | 1.2 | 1.4 |
| Total charge (percentage of total charges for surgical encounters) | $55.6 billion (17.7%) | $289.9 billion (82.3%) |
| Mean charge per visit/day | $6,100 | $39,900 |
| Source: Agency for Healthcare Research and Quality. Statistical Brief #86, February 2010. | ||