title: Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.
abstract: OBJECTIVE
  This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings.
  
  
  METHODS
  A time series study was conducted using the Premier Hospital Perspective®Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective.
  
  
  RESULTS
  During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective.
  
  
  CONCLUSIONS
  The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities.
  
  
  CONCLUSIONS
  Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases indicated a financial benefit for shifting from inpatient to outpatient MIS.
authors.affiliation: a Intuitive Surgical, Inc. , Sunnyvale , CA , USA.
authors.forename: Chao
authors.initials: C
authors.lastname: Song
authors.affiliation: a Intuitive Surgical, Inc. , Sunnyvale , CA , USA.
authors.forename: Emelline
authors.initials: E
authors.lastname: Liu
authors.affiliation: a Intuitive Surgical, Inc. , Sunnyvale , CA , USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Tackett
authors.affiliation: b Department of Global Health Management and Policy , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA.
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
authors.affiliation: c Providence Saint John's Health Center , Marina Del Rey , CA , USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000379:methods; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures / Q000191:economics* / Q000379:methods; D005260:Female; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods; D006801:Humans; D000069290:Incisional Hernia / Q000453:epidemiology / Q000601:surgery*; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000379:methods; D009765:Obesity / Q000191:economics / Q000453:epidemiology; D014481:United States; D055815:Young Adult
keywords: Budget impact; Medicare; costs; hernia repair; minimally invasive surgery; outpatient; reimbursement