The University of Pennsylvania’s Leonard Davis Institute (LDI) of Health Economics has posted a Q&A with one of the authors of a study that examines the ongoing shit of surgeries to the outpatient setting.
The study, “Inpatient to Outpatient Shifts in Surgical Care: Persistence of COVID-19 Era Changes and Socioeconomic Variations,” was published in Medical Care Research and Review in December; you can read it in full here. The study found that more than 65% of surgeries in the U.S. are now performed on an outpatient basis, driven particularly by orthopedics, ophthalmology, and gastroenterology procedures.
LDI adds, “Over the next three years, federal regulators are phasing out the Inpatient Only List of surgeries that must be performed in a hospital, starting with 285 mostly musculoskeletal procedures in 2026 … The trends suggest a permanent shift to outpatient care.”
LDI interviewed co-author Angela T. Chen, whose team, it should be noted, relied entirely on claims data from Philadelphia-area insurance company Independence Blue Cross. Some highlights from Ms. Chen:
- “Looking 10 years ahead, outpatient surgery will likely encompass even more complex cases as technology continues to reduce surgical risk and improve recovery at home.”
- “Equally important is our finding related to equity: patients from lower-income areas experienced a 6% decline in procedure volume, while those in higher-income areas saw a 5.2% increase.”
- “For payors, the shift holds real promise – in our study, total costs for joint replacements fell by roughly $6,000 to $7,000 per case as more procedures moved outpatient. However, patient out-of-pocket costs stayed largely the same, meaning those savings were not passed on to patients. For hospitals, especially those serving higher-need populations, losing high-volume inpatient procedures may create financial challenges. For taxpayers, the impact is less clear; if Medicare pays substantially less for outpatient care, the gains could be real, but if volume increases offset per-procedure savings, the net impact may be modest … In our data, we saw not only durable shifts to outpatient settings but also emerging socioeconomic differences in who received care, which raised important questions about access and equity.”
- “Our study draws on claims from a single commercial insurer in southeastern Pennsylvania, which limits generalizability to other regions, payor types, and care settings. In particular, it excludes traditional Medicare, Medicaid, and uninsured patients — the groups most likely to face barriers to outpatient care and among whom disparities may be most pronounced.”
- “Payment policy should refine risk adjustment so providers are not penalized for caring for higher-need patients, and benefit design reforms should work to pass system-level savings through to patients. Investment in outpatient surgical infrastructure in underserved communities will be essential to ensuring efficiency gains do not come at the cost of equity.”
Read the full interview with Ms. Chen here.
