203 posters, 14 topics, 5 sessions, 817 authors, 256 institutions

The AAPS 102nd Annual Meeting

May 18-21, 2024 | The Westin Copley Place, Boston, MA

D96

Same-day Plastic Surgery: Evaluating The Association Of Facility Ownership With Access, Surgical Cost, And Unexpected Postoperative Visits Among Propensity-matched Patients

Preview of Same-day Plastic Surgery: Evaluating The Association Of Facility Ownership With Access, Surgical Cost, And Unexpected Postoperative Visits Among Propensity-matched Patients

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Poster Presenter

Joseph Fahmy

Authors

Joseph Fahmy, Trista Benitez, Zhongzhe Ouyang, Lu Wang, Kevin Chung

Affiliations

University of Michigan, Research Fellow, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Department of Biostatistics, University of Michigan School of Public Health, Medical Student, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Professor, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School

Part of Topic

Education/Practice Management/Other

Same-day Plastic Surgery: Evaluating The Association Of Facility Ownership With Access, Cost, And Unexpected Postoperative Visits Among Propensity-matched Patients

Joseph N. Fahmy, MD, MS 1; Trista M. Benítez, MPH1; Zhongzhe Ouyang, MS2; Lu Wang, PHD2; Kevin C. Chung, MD, MS1

1.Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA 2. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA

STUDY PURPOSE

42% of cosmetic and 25% of reconstructive surgeries are performed in Ambulatory Surgery Centers (ASCs). Freestanding ASCs (F-ASCs) and Hospital-owned ASCs (HO-ASCs) are 50% less costly than hospital outpatient departments (HOPDs). Plastic Surgeons frequently own and operate ASCs. Studies evaluating cost and access trends among ASCs by ownership are necessary in the setting of current policy initiatives aiming to reduce spending on surgical care and shift care to ASCs.

METHODS

The 2016-2019 State Ambulatory Surgery Databases from Florida, New York, and Maryland were queried for common plastic surgery procedures, including laceration repair, local tissue rearrangement, skin grafting, panniculectomy, reduction mammaplasty, breast reconstruction, and revision breast reconstruction. The resulting 128,805 patients were propensity matched using individual comorbidity data for all three same-day surgery facility types. Access, charges, and postoperative visits were evaluated using logistic regression.

Medicare FFS

39% less likely to use HO-ASCs (95% CI: 0.55 to 0.69, p<0.001)

*increased by 2%/quarter (95% CI: 1.01 to 1.03, p<0.001)

22% less likely to use F-ASCs (95% CI: 0.70 to 0.88, p<0.001)

*increased by 1%/quarter (95% CI: 1.00 to 1.02, p=0.04)

Medicaid

32% less likely to use HO-ASCs (95% CI: 0.55 to 0.76, p<0.001) 84% less likely to use F-ASCs (95% CI: 0.14 to 0.19, p<0.001) *increased by 3% per quarter (95% CI: 1.02 to 1.05, p<0.001)

7-day ED or Hospital Admissions_______________

F-ASC 70% lower odds versus HOPD

95% CI: 0.27 to 0.33, p<0.001

HO-ASC: 53% lower odds versus HOPD

95% CI: 0.49 to 0.57, p<0.001

Surgery Charges____________________________

HO-ASC: $7,523 less than HOPD

95% CI:-$7,899 to –$7,147, p<0.001

F-ASC: $19,058 less than HOPD

95% CI:-$19,446 to -$18,669, p<0.001

Charge Trends___________________________

HO-ASC: no change versus HOPD over time

OR: 1.00, 95% CI: 0.98 to 1.1, p=0.2

F-ASC: 8% less per quarter versus HOPD over time

95% CI: 0.89 to 0.96, p<0.001

CONCLUSIONS

Incentives encouraging ASC use are maligned with same-day surgery payment policy in the US. Site-neutral payment policies that decrease HOPD reimbursement will improve access and constrain costs. Narrowing ASC access disparities suggest that F-ASCs may improve access to same-day plastic surgery care.