The Impact of Insurance Status on Patient Placement into Inpatient and Outpatient Orthopedic Surgical Centers in the United States

Abstract

Abstract Background Innovation has fueled the shift from inpatient to outpatient care for orthopaedic joint arthroplasty. This transformation begs the question, what factors help assign care-settings to specific patients for the same procedure? While one answer seems to be the comorbidities suffered by the patients, recent research may point to a more complex determination. Primarily, differences in reimbursement structures and patient characteristics across various insurance statuses could influence these decisions. Methods Retrospective binary logistic and ordinary least square (OLS) regression analyses were employed on de-identified inpatient and outpatient orthopaedic arthroplasty data from Albany Medical Center from 2018-2022. Data elements included surgical setting (inpatient vs. outpatient), covariates (age, gender, race, obesity, smoking status), Elixhauser comorbidity indices, and insurance status. Results Patients insured by Medicare were significantly more likely to be placed in inpatient care-settings for total hip, knee, and ankle arthroplasty when compared to their privately insured counterparts even after Centers for Medicare and Medicaid Services (CMS) removed each individual surgery from its inpatient-only-list (1.65 (p<0.05), 1.27 (p<0.05), and 12.93 (p<0.05) times more likely respectively). When compared to patients insured by the other payers, Medicare patients did not have the most comorbidities. Conclusions Medicare patients were more likely to be placed in inpatient care-settings. The age of these patients correlates with the presence of comorbidities. However, it is of value to note that Medicare patients billed for outpatient services experience higher coinsurance rates. Level of Evidence: III