title: The Influence of Insurance Type on Management of Carpal Tunnel Syndrome: An Analysis of Nationwide Practice Trends.
abstract: BACKGROUND
  The purpose of this study was to evaluate the impact of insurance type on use of diagnostic testing, treatments, and the efficiency of care for patients with carpal tunnel syndrome.
  
  
  METHODS
  The 2009 to 2013 Truven MarketScan Databases were used to identify adult patients with carpal tunnel syndrome. Insurance type was categorized as fee-for-service versus capitated managed care. Multivariable regression models were created to evaluate the relationship between insurance type and costs, number of visits, treatment, and electrodiagnostic study use, and controlling for demographic characteristics and comorbidities.
  
  
  RESULTS
  The cohort included 233,572 patients, of which 86 percent carried fee-for-service insurance. Predicted probabilities were clinically similar between the capitated and fee-for-service insurance types for therapy (0.23 versus 0.24), steroid injection (0.07 versus 0.09), and electrodiagnostic study use (0.44 versus 0.47). The difference in predicted probabilities between the insurance groups was greatest for surgery use (0.22 versus 0.28 for managed care and fee-for-service, respectively). The mean number of visits was similar between the two groups (2.1 versus 2.0 visits). In the controlled analysis, managed care was associated with a 10 percent decrease in cost compared to patients with fee-for-service (p < 0.001).
  
  
  CONCLUSIONS
  Managed care was associated with a lower probability of surgery than fee-for-service, but similar use of less costly services. These data may be used to predict future practice trends with increased implementation of bundled payment reimbursement. Routine collection of validated patient outcomes measures is critical to assess patient outcomes associated with anticipated reduction of surgical services.
  
  
  METHODS
  Risk, II.
authors: Ann Arbor, Mich.|From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, and the University of Michigan Health System.
authors: Erika D
authors: ED
authors: Sears
authors: Ann Arbor, Mich.|From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, and the University of Michigan Health System.
authors: Peter R
authors: PR
authors: Swiatek
authors: Ann Arbor, Mich.|From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, and the University of Michigan Health System.
authors: Hechuan
authors: H
authors: Hou
authors: Ann Arbor, Mich.|From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, and the University of Michigan Health System.
authors: Kevin C
authors: KC
authors: Chung
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002204:Capitation Fee / Q000706:statistics & numerical data; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000191:economics* / Q000601:surgery / Q000628:therapy; D017046:Cost Savings; D019299:Decompression, Surgical / Q000191:economics / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics; D019468:Disease Management; D004568:Electrodiagnosis / Q000191:economics / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007267:Injections; D007348:Insurance, Health; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011336:Probability; D012051:Reimbursement Mechanisms; D014481:United States; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones