Rising Patient Out-of-Pocket Costs for Common Outpatient Orthopaedic Foot and Ankle Surgeries

Abstract

Category: Other Introduction/Purpose: The purpose of this study is to characterize out-of-pocket (OOP) cost trends in both elective and trauma foot and ankle surgeries for commercially insured patients. Secondarily, we sought to compare the OOP costs of these surgeries between hospital-based outpatient departments (HOPDs) and ambulatory surgical centers (ASCs), as well as insurance plan types. Methods: Adult patients who underwent elective or trauma foot and/or ankle surgeries between 2010 and 2020 were identified using the MarketScan Database. Demographic, procedural, and financial data were recorded. The primary outcome was OOP costs, which were defined as the sum of the deductible, coinsurance, and copayment for each episode of care. Monetary data were adjusted to 2020 dollars. General linear regression, Kruskal-Wallis test, and Wilcoxon-Mann-Whitney test were used for analysis, as appropriate. Alpha was set at 0.05. Results: A total of 966,095 patients (806,707 elective and 159,388 trauma) underwent common outpatient foot and ankle surgeries between 2010 and 2020. Trauma surgeries generated significantly higher mean OOP costs than elective procedures ($1438.79 versus 1058.53, P< 0.001). OOP costs were significantly lower for procedures performed in ASCs compared to HOPDs ($1071.09 vs $1126.96, P< 0.001). This trend was driven by significantly higher coinsurance for HOPDs ($727.98) versus ASCs ($622.95) (P < 0.001). Of the insurance plans studied, high deductible health plans had the highest average OOP costs. Average OOP costs for common outpatient foot and ankle surgeries increased by 55.2% from $875.11 in 2010 to $1357.86 in 2020. Conclusion: OOP costs for foot and ankle surgeries have increased significantly since 2010. Average OOP costs from surgeries performed in ASCs were less than in HOPDs. Patients enrolled in HDHPs tended to incur the greatest average OOP costs. As direct costs for patients increase over time, it is critical to be aware of this financial burden and work towards improving access to necessary care.