Surgery in a hospital doesn’t necessarily lead to better outcomes than surgery in a surgical center

Does paying more to have your outpatient surgery done at a hospital, rather than at a freestanding surgical center, lead to better care? A new study led by James C. Robinson, professor of health economics at UC Berkeley School of Public Health, says no.

In an investigation published in the April issue of The American Journal of Managed Care, Robinson and his team found that the higher prices typically charged by hospitals for four common surgeries were not justified by higher quality, as measured by the rate of post-surgical complications.

The researchers analyzed more than 2 million national Blue Cross Blue Shield insurance claims from 2019-2020 for patients aged 18 to 65 who received a colonoscopy, knee or shoulder arthroscopy, or cataract removal surgery, and calculated the prices and rates of complications for each procedure.

They found large differences in price, but very little difference in the rate of post-surgery complications.

After adjusting for patient characteristics, risk, and geographic market location, the authors wrote, prices paid for colonoscopies in hospitals were nearly 55% higher than those charged in ambulatory surgery centers; hospital prices for arthroscopy and cataract removal were roughly 44% higher.

A small difference in rates of post-surgery complications, according to the study, was found regarding colonoscopy: hospitals had a slightly higher rate of complications over a 90-day interval, compared to ambulatory surgery centers. But the rates were statistically similar when measured over the seven and 30-day intervals. Rates were similar between the two sites of care for arthroscopy and cataract removal.

“We were looking at whether a patient got a surgical infection, or had a general complication, like a stroke,” Robinson said. “The rates were very low. These are elective, voluntary procedures done on non-aged patients with private insurance.”

To Robinson, the hospitals’ higher prices are not warranted without higher quality. But he also believes it would be a mistake for policymakers and insurers to force patients to go to the cheaper ambulatory surgical centers for their procedures.

“That isn’t desirable either,” he said. “The real solution is that the hospitals should charge the same price as the ambulatory centers.”

“You really need facility-specific information on price and quality,” he said. “And that information is almost impossible to get. The American healthcare system is so inefficient. We’re just sloshing around in it.”