Date of Award

2019

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Daniel L. Brinton

Second Advisor

Kit N. Simpson

Third Advisor

Sophia A. Traven

Abstract

To date, there has been only one study comparing costs of outpatient versus inpatient TSA. This study sought to understand the differential costs, complications, and readmission rates between TSAs performed in an outpatient versus inpatient setting in lieu of the Affordable Care Act and ICD-10. Archival data were obtained from Medicare 5% limited data set and MarketScan® privately insured billing data from 2016 for patients aged 55-74, propensity score matching 1:1 to ensure similar propensity for surgery in the outpatient setting. In total, 1,578 patients underwent TSA in our dataset: 374 outpatient and 1,204 inpatient. Following propensity score matching, 738 well-matched TSA patients were included in this study-369 each in inpatient and outpatient. In adjusted analysis, total costs for inpatient TSA were 87% higher than outpatient $36,033 vs. $19,253 (p=0.0001). For overall complication rates, inpatient TSAs had an approximately 54% overall lower odds of a medical or surgical complication than those performed in an outpatient setting (Odds ratio [OR] 0.436, 95% CI: 0.236-0.806, p=0.008). In conclusion, our results show that outpatient TSA provides a significant cost reduction. However, there was an increase in odds of complication, which is contrary to previous work. Therefore, future work should focus on evaluating outpatient TSA, its value, and its safety within ICD-10 and the ACA. Additionally, healthcare leaders should focus on identifying and directing high-risk patients toward inpatient settings, while focusing on value.

Rights

All rights reserved. Copyright is held by the author.

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