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Surgical Setting and Cost Effectiveness in Trigger Finger Release
Elliot P. Robinson, MD; Glenn Gaston, MD
1Hand Surgery Fellowship, University of Virginia, Charlottesville, VA; 2OrthoCarolina, Carolinas Medical Center, Charlotte, NC

HYPOTHESIS: Office-based procedure (OPR) room A1 pulley release offers considerable cost savings compared to stand-alone surgery center (SASC) and hospital ambulatory surgery centers (HASC), without any increased risk to the patient. Furthermore, current reimbursement schemes do not encourage the adoption of cost-effective practices.

METHODS: Billing records in one academic private practice were queried to generate a consecutive list of patients undergoing A1 release (Code 26055) between January 2010 and May 2012. 50 patients from each setting were chosen (HASC, SASC, or OPR). Releases in the OPR were typically performed under field sterility with local anesthesia with epinephrine, while releases in the surgical centers were performed with general sedation, local anesthesia, tourniquet and full prep and drape. Clinical data regarding surgical site, concurrent procedures, and complications were extracted from the medical record. Data regarding payer source, billing and collections were obtained from business office records.

RESULTS: 50 patients had one or multiple trigger finger releases in each of the three surgical settings for a total of 150 patients with a grand total of 197 releases. There were 6 complications (4%) evenly distributed among centers. One infection required I&D in the OR, while the remaining site reactions or infections resolved with observation or PO antibiotics. There were no re-operations for persistent triggering. Total paid cost of care varied based upon the setting. OPR costs ranged from $463 to $669. SASC ranged from $1528 to $2292. The highest cost was for the HASC at $2979. Release performed in the OPR instead of SASC saved payers between $859 (56%) and $1829 (80%). Even greater cost savings were seen comparing the OPR with the HASC, with a difference of $2515 (84%). The mean physician reimbursement for code was $609. When performed at the OPR, the cost of supplies and assistant time must be subtracted. This was estimated at $90, which translates to a 15% decrease in reimbursement.

SUMMARY:

  1. A1 release can be safely performed under field sterility with local anesthesia with epinephrine in an OPR.
  2. OPR A1 release provides significant cost-savings (56-84%) compared to SASC and HASC.
  3. Payer reimbursement schemes lead to limited surgeon incentive to decrease the use of standard OR resources, and therefore higher costs.

    LEVEL OF EVIDENCE: Economic and Decision Analyses Level III


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