Hip replacement surgery at ASCs vs. hospital outpatient

Many patients are offered the option to have their hip replacement surgery in an ambulatory surgery center (ASC) or at the local or some other hospital.  Total hip arthroplasty, the actual formal name for a hip replacement surgery is now documented as “can be safely performed” in both ASC and hospital outpatient settings, according to a study published in The Journal of Arthroplasty.

In that study, researchers analyzed 3,063 total hip replacement surgery procedures performed by two surgeons, including 335 in an ASC and 630 in a hospital outpatient setting. (That’s a whole lot of hip surgery for two surgeons!)

They compared subgroups in ASC and hospital outpatient settings.

The ASC and hospital outpatient subgroups had similar 90-day complication, revision, all-cause re-operation, emergency department visit and readmission rates:

1. The complication rate was 3.9 % (120) for ASCs and 3.8 % (116) for hospital outpatient settings. 

2. Revision rates were 0 percent in ASCs and 0.3 % (9) for hospital outpatients.

3. The all-cause re-operation rate for ASCs was 0.3 % (9), compared to 0.8 % (25) for hospital outpatient settings. 

4. Emergency department visits occurred in 0.9 percent of ASC cases (28) and 0.3 percent (9) of hospital outpatient cases. 

5. Readmission rates were 0.6 % (18) in the ASC and 1.4 % (43)  in the hospital outpatient setting.

The price difference between the two settings is the most staggering difference.  You can have your surgery at the hospital which could run about $38,000 or you can opt to have your surgery at an ASC for about 50% less. 

Why the huge gap in price difference?

• Hospitals cost a lot of money to operate. For example, it takes roughly 300 gallons of water, per bed, per day to operate a hospital. The overheads in the ASCs are remarkably smaller and significantly more eco-friendly.
• Administrators of many hospitals are paid over a million dollars per year in salary and compensation. Administrators of ASCs are paid about 85% less. Administrative head count is smaller and leaner in the ASC than at the hospital. Nursing pay is often comparable in both because there’s always the risk that nurses will go to work at the higher paying hospital, if the gap between the jobs is too great.
• Margins are often much lower by  internal policy in the ASC setting.  For the majority of US hospitals that are not-for-profit, they claim to use the much larger margins to fund public benefit. Regardless, that higher margin is coming out of your pocket, not theirs. You are funding that public benefit cause. And you won’t really see the same tax deductible benefit if you wrote a check to their foundation for the same amount as the margins they charge for the surgery. Feeling less philanthropic? Opt for the ASC at the lower price which is usually for-profit and pays taxes on what you pay them, which also get used for public benefit. 
• The hospital may be the only hospital in your town and doesn’t feel compelled to compete. The ASC competes directly with the hospital outpatient department and feels compelled to offer a better price to attract patients. Many ASCs now offer bundled prices that include the hip prosthesis in the price for self-pay patients. The hip prosthesis can add as much as $3500-$6000 (depending on make, model and volume discounts) to the costs of the surgery. When you check prices, always ask if the price includes the prosthesis or not. You can avoid a nasty cost surprise by asking first.