Commercial insurers paid an average of $1,489 more for common procedures at hospital outpatient departments than at ASCs in 2024, a 78% mark-up, according to a study published in Health Affairs in October.
Researchers analyzed negotiated rate data from UnitedHealthcare, Cigna and BlueCross BlueShield for 13 high-volume outpatient procedures that together account for nearly two-thirds of all outpatient surgical cases.
By comparison, Medicare paid $633 more for the same procedures when performed at HOPDs rather than ASCs, a 97% mark-up.
Among the three commercial payers, Cigna had the narrowest gap, at $327. The insurer contracted with just 14% of HOPDs in applicable markets, compared with an average of 76% each for United and BlueCross BlueShield. If those two payers paid Cigna’s average HOPD rates for the study’s 13 procedures, they would save an estimated $1.4 billion annually.
The findings suggest that narrower networks and site-of-care selection may play a significant role in reducing commercial outpatient spending — particularly for services that can be safely performed in ASC settings.
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