Sports medicine procedures cost far less in ASCs than HOPDs

Editor's Note

Sports medicine surgical procedures for Medicare patients cost significantly less in ambulatory surgery centers (ASCs) compared with hospital outpatient departments (HOPDs), according to a study published by the Orthopaedic Journal of Sports Medicine on August 29. Researchers analyzed Medicare Procedure Price Lookup data for 62 commonly billed outpatient shoulder, knee, and hip procedures and found consistent savings across every category except surgeon fees.

The study reports total costs at ASCs were on average 40% lower than at HOPDs. Facility fees were 45% lower, Medicare payments 40% lower, and patient payments 37% lower. Surgeon fees did not differ between settings. Patients faced an average increase of $400 to $500 in out-of-pocket expenses when procedures were performed in HOPDs, primarily due to higher facility fees.

When broken down by procedure type, ASC vs HOPDs price differences averaged:

• $3,622 vs $6,261 for shoulder procedures
• $4,236 vs $6,668 for knee procedures
• $3,583 vs $6,671 for hip procedures.

In each category, Medicare payments and patient payments were substantially lower at ASCs.

The authors note US healthcare costs continue to rise, with national health expenditures expected to grow 5.4% annually through 2028. Medicare represents more than one-fifth of this spending, fueling pressure to reduce costs without sacrificing quality. ASCs, with lower overhead and streamlined operations, appear well-positioned to offer cost-efficient alternatives while maintaining safety and outcomes equivalent to hospital outpatient care.

While the study highlights large savings potential, it also cautions that not all patients are candidates for procedures in ASCs. HOPDs remain essential for individuals with complex medical needs or those requiring access to additional specialists and extended observation. Patient selection, comorbidities, and social factors must all be considered when determining the safest surgical site.