Outpatient Urological Services Costs Up When Done in a Hospital

Wide variation in costs, but significantly lower at ambulatory surgery centers, physician offices

THURSDAY, Oct. 25 (HealthDay News) -- Outpatient urological procedures are performed at lower cost in ambulatory surgery centers and physician offices compared to hospitals, according to a study published online Oct. 24 in The Journal of Urology.

To examine whether payments for outpatient surgery vary by location of care, John M. Hollingsworth, M.D., from the University of Michigan in Ann Arbor, and colleagues analyzed national Medicare claims from 1998 to 2006 to identify elderly patients who underwent one of 22 common outpatient urological procedures. All relevant payments made during the 30-day claims window were measured and categorized according to type.

The researchers found that there was wide variation in the average total payments for outpatient surgery episodes, from $200 for urethral dilation in the physician office to $5,688 for hospital based shock wave lithotripsy. Ambulatory surgery centers and physician offices were associated with lower overall episode payments than hospitals for all but two procedure groups. For urodynamic procedures performed at ambulatory surgery centers, the average total payments were less than a third of those conducted at hospitals (P < 0.001). Office-based prostate biopsies were nearly 75 percent less costly than those performed at hospitals (P < 0.001). The biggest driver of these differences were outpatient facility payments.

"Our data support policies that encourage the provision of outpatient surgical care in less resource intensive settings," the authors write. "Moving forward, further research should consider how indirect costs are dispersed across hospitals, ambulatory surgery centers, and physician offices."

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