Researchers gathered data from 3,962 patients in the California Public Employees’ Retirement System who underwent knee arthroscopy or shoulder surgery in the three years before implementing reference-based benefits and compared them to 2,505 CalPERS patients who had surgery in the two years after implementation. There was also a control group of 57,791 patients who did not have reference-based benefits.
The researchers found:
1. In the second year of the program, there was a shift towards freestanding ASC use. ASC utilization increased 14.3 percentage points for knee arthroscopy and 9.9 percentage points for shoulder arthroscopy.
2. When the ASCs experienced an increased utilization, hospital-based outpatient facilities showed a decrease in utilization.
3. The average price for a CalPERS beneficiary fell 17.6 percent for knee procedures and 17 percent for shoulder procedures.
4. The reference-based benefits shift wasn’t associated with a surgical complication rate change.
5. In the two years after reference-based benefits, CalPERS saved $2.3 million — or 13 percent — on knee and shoulder arthroscopies.
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