Retrospective analysis of trends in surgery volumes between 2016 and 2019 and impact of the insurance deductible: Cross-sectional study

• Authors: Dhairya Shukla, Medical College of Georgia; Sharvil Patel, Emory University; Lesley Clack, University of Georgia; Tyler B Smith, Athens Orthopedic Clinic; Michael S Shuler, Athens Orthopedic Clinic
• Journal Title: Annals of Medicine and Surgery
• Volume: Volume 63
• Publisher: Elsevier Ltd | 2021-03-01, Pages 102176-102176
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.amsu.2021.02.022
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Ambulatory surgery centers; Health policy; Insurance deductible; Linear regression; Orthopedic surgery

Abstract

Background: Understanding trends in surgical volumes can help Ambulatory Surgery Centers (ASCs) prevent clinician burnout and provide adequate staffing while maintaining the quality of patient care throughout the year. Health insurance deductibles reset in January each year and may contribute to an annual rhythm where the levee of year-end deductibles is breached in the last few months of every year, resulting in a flood of cases and several accompanying challenges. This study aims to identify and analyze monthly and yearly surgical volume patterns in ASCs and explore a relationship with the deductible reset. Methods: De-identified, aggregate visit data for 2016–2019 were obtained retrospectively from 14 ambulatory surgery centers within the same benchmarking consortium in the Southeast. The ASCs subspecialty types consisted of orthopedics, urology, otolaryngology, and multispecialty. Kaiser Family Foundation survey data from 2016 to 2019 was used to inform deductible trends. Augmented Dickey-Fuller tests, linear regressions, and two-sample T-tests were conducted to explore and establish patterns in surgical volume between 2016 and 2019. Results: Overall, average orthopedic surgical volume increased 38.04% from January to December in 2016–2019 with an average difference of 64 cases (95% CI: 47–80), while that of all ASCs combined increased 19.24% within the same timeframe with an average difference of 37 cases (95% CI: 21–52). Average health insurance deductibles rose 12% from $1476 to $1655 within the same timeframe. Regression analysis showed a stronger association between year and volume for orthopedic ASCs (R (Claxton et al., 2019) [2] = 0.796) than for all ASCs combined (R (Claxton et al., 2019) [2] = 0.645). Regression analysis also showed a stronger association between month and volume for orthopedic ASCs (R (Claxton et al., 2019) [2] = 0.488–0.805) than for all ASCs combined (R (Claxton et al., 2019) [2] = 0.115–0.493). Conclusion: This study is first to identify regular and predictable yearly and monthly increases in orthopedic ASCs surgical volume. The study also identifies yearly increases in surgical volume for all ASCs. The combination of increasing yearly demand for orthopedic surgery and growing association between month and volume leads to an unnecessary year-end rush. The study aims to inform future policy decisions as well as help ASCs better manage resources throughout the year.