PURPOSE: Plastic surgeons frequently use and own ambulatory surgery centers (ASCs). Research suggests that freestanding ASCs (F-ASCs) and hospital-owned ASCs (HO-ASCs) provide more efficient, less costly care relative to hospital outpatient departments (HOPDs). Limited research has analyzed access, cost, and unplanned postoperative visits between ASC types for common same-day plastic surgeries, including laceration repair, local tissue rearrangement, skin grafting, panniculectomy, reduction mammaplasty, breast reconstruction, and revision breast reconstruction.
METHODS: The Healthcare Cost and Utilization Project all-payer databases were queried. Patients were propensity-score matched by age and individual comorbidity data. Multivariable regression was used to assess disparities in access, cost, and unexpected hospital visits by facility type.
RESULTS: In total, 128,805 matched patients were included. Relative to privately insured patients, public insurance beneficiaries experienced lesser odds of HO-ASC (Medicare OR:0.85, 95%CI:0.80 to 0.90, p<0.001; Medicaid OR:0.66, 95%CI:0.63 to 0.70, p<0.001) or F-ASC use (Medicare OR:0.81, 95%CI:0.76 to 0.86, p<0.001; Medicaid OR:0.24, 95%CI 0.22 to 0.26, p<0.001). Relative to HOPDs, HO-ASC charges were $7,523 less (95%CI:-$7,899 to -$7,147, p<0.001), while F-ASC charges were $19,058 less (95%CI:-$19,446 to -$18,669, p<0.001). Odds of 7-day postoperative emergency room or hospital visits for those treated at F-ASC were 0.3 times lower than the patients treated at HOPDs.
CONCLUSION: F-ASC based surgery is less costly and associated with fewer postoperative visits than alternative same-day surgery sites. Additionally, disparities in F-ASC access are likely driven by primary payer. Policy promoting independent ASC ownership and F-ASC use through reimbursement parity will yield substantial savings for the US healthcare system.