The purpose of this investigation was to examine the economic patterns of outpatient plastic surgical cases performed within an AHC.

For FY 2003 & 2004, the University of Michigan Health System's accounting database was queried to identify all outpatient plastic surgery cases from four surgical facilities. Total facility revenue, cost and margin were calculated per case. Contribution margin (total revenue minus variable cost) was compared to case time to determine average contribution margin (ACM) per OR case minute.

A total of 3603 cases (3457 reconstructive, 146 aesthetic) were identified. Payers included Blue Cross (36.6%), HMO (28.7%), other commercial payers (18.4%), Medicare/Medicaid (13.5%) and self-pay (2.8%). Aesthetic procedures yielded higher average total margins ($3,316) compared to reconstructive procedures ($1,462). Per minute ACM resulted in similar margins for both aesthetic ($25.68) and reconstructive ($26.86) cases. The most profitable cases were laser procedures ($66.20) and facial trauma ($32.17). The least profitable cases were breast reduction ($17.46), hand arthroplasty ($13.93). Cases performed at outpatient facilities (n=1352) yielded higher per min ACM ($29.09) compared to hospital-based facilities (n=1721, $25.07).

Within AHCs, aesthetic and reconstructive cases yield similar profitability when controlling for case duration. On average, cases performed at dedicated outpatient surgical facilities yield higher profitability.