About the Study
The amount paid for common outpatient healthcare services differs significantly whether they are performed in a hospital outpatient department (HOPD), an ambulatory surgery center (ASC), or a physician’s office.
While site-neutral payments for services paid by Medicare began in 2017, little is known about price trends for outpatient services in the commercial insurance sector.
To examine the difference in allowed costs for commonly rendered outpatient services across settings and over time, we analyzed national PPO commercial claims data for approximately 133 million members from 2017 through 2022 (we analyzed 2014 through 2022 for office visits).
The study population comprised members who resided in the U.S. and had medical and hospital benefits and primary health care coverage through a large commercial insurance provider. Managed Medicaid and Medicare Advantage members were excluded from the study.
We selected the following procedures for analysis:
- Cataract surgery
- Clinic visits
- Colonoscopy (diagnostic and screening)
- Ear tympanostomy
- Mammography
The findings revealed significantly higher allowed costs for all six procedures in the HOPD setting, with these cost differences increasing more rapidly over time compared to ASCs and office settings.
This analysis was conducted for the Blue Cross Blue Shield Association and released on September 14. Read the BCBSA press release.
Allowed costs for colonoscopy screenings rendered in an HOPD were 32% higher than those performed in an ASC. Costs for colonoscopy screenings in the office setting were even lower – only half as much as in an HOPD.
