Place of Service Has Not Changed for Local Hand Surgery Cases

Purpose Emerging evidence demonstrates cost savings when low-acuity hand procedures are performed in office-based settings compared with hospital facilities or ambulatory surgery centers (ASCs). However, it is unclear whether these advantages translated into broader adoption of office-based care. Accordingly, this study sought to evaluate temporal trends in procedural setting and reimbursement rates for three common hand procedures. Methods A retrospective analysis was conducted using Centers for Medicare & Medicaid Services Physician/Supplier Procedure Summary and Physician Fee Schedule datasets from 2011 to 2023. All fee-for-service Medicare Part B claims for carpal tunnel release (CTR), trigger finger release (TFR), and de Quervain release (DQR) were included. The primary outcome was the shift in the place of service: office, outpatient hospital, inpatient hospital, or ASC. The secondary outcome was the facility and nonfacility reimbursements for each procedure. Poisson and mixed-effects regression models were used to evaluate temporal volume and reimbursement trends. Results From 2011 to 2023, ASCs were the dominant setting, accounting for 44.9% of CTR, 50.2% of TFR, and 53.3% of DQR procedures. The proportion of office-based procedures increased modestly across all procedures (CTR: 3.94% to 5.55%; TFR: 7.54% to 12.31%; DQR: 4.31% to 6.78%). Furthermore, although nominal reimbursements increased over time, overall inflation-adjusted reimbursements declined consistently after 2013. Notably, inflation-adjusted reimbursements across the 12-year period significantly decreased for TFR from $586.70 ± $183.98 to $496.64 ± $178.48 and CTR from $585.11 ± $44.93 to $489.69 ± $40.60. Conclusions Despite evidence supporting the safety and cost savings of office-based hand procedures, minimal migration toward office-based care was observed for low-acuity hand procedures. The authors hypothesize that a realignment of reimbursement policy may incentivize office-based care. Type of study/level of evidence Economic/decision analysis III.