About the Issue Brief
Outpatient services are commonly performed in three settings: Hospital Outpatient Departments (HOPDs), ambulatory surgery centers (ASCs), and physician offices. The negotiated prices paid for these services vary widely depending on the setting. BHI’s September 2023 study calculated price differences for six commonly performed outpatient healthcare services and found that when those services are performed in an HOPD, the costs are substantially more than when performed in an ASC or a physician’s office.
To understand the implications of these differences more fully, this follow-up study examines the cost of thousands of different services provided in these three sites of care from 2017-2022.
BHI used a national commercial data set of 123 million lives to evaluate how prices differ across sites of care. BHI adopted a similar methodology to that of a recent MedPAC study by using the Center for Medicare & Medicaid Services’ (CMS) Ambulatory Payment Classifications (APC) to group and classify services. Each APC includes a set of services used to treat people with similar clinical conditions and have similar resource intensity.
This analysis was conducted for the Blue Cross Blue Shield Association and released on December 14.
APC Level 3 Nerve Injections primarily consist of epidural and nerve block injections. In 2022, the average APC prices in the HOPD were 85% higher than in the ASC setting and 300% higher than in the office setting.
