ASCs have become increasingly popular and heavily utilized by both patients and healthcare providers for a number of reasons, including their ability to offer the same procedures as HOPDs at a lower cost.
Here are 10 numbers demonstrating ASCs cost effectiveness:
1. Procedures at out-of-network ASCs were cheaper than in-network HOPDs across four procedure types analyzed in a study published Oct. 6 in The American Journal of Managed Care. The study analyzed commercial medical claims data from all 50 states, comparing insurer-paid amounts, patient out-of-pocket payments and balance billing amounts for four common adult outpatient surgeries: arthroscopy, cataract, colonoscopy and upper gastrointestinal procedures.
2. Compared with in-network ASCs, insurers paid 32% more to out-of-network ASCs, and 110% more to both in-network and out-of-network HOPDs.
3. Compared with in-network ASCs, patient out-of-pocket payments were 103% higher at in-network HOPDs, 311% higher at out-of-network ASCs and 287% higher at out-of-network HOPDs.
4. Overall prices for outpatient surgeries were significantly higher outside of ASCs. PRices were 79% higher at out-of-network ASCs, 109% higher at in-network HOPDs and 140% higher at out-of-network HOPDs compared with in-network ASCs.
5. Facility charges followed the same pattern. Out-of-network ASCs charged 73% more, and out-of-network HOPDs charged 108% more than in-network ASCs. Even in-network HOPDs charged about 37% more than in-network ASCs.
6. According to a study published recently in the Journal of Market Access and Health Policy, between 2001 and 2021, facility fees grew 60% (2.4% year-over-year) compared to just 11% growth (0.5% year-over-year) for professional fees.
7. Across specialties, HOPD reimbursement ranged from 124% to 861% of ASC/office rates for Medicare and 111% to 1,346% for commercial payers.
8. Echocardiogram (CPT 93306):
- Medicare: HOPD $593 vs. office $196 (303% higher)
- Commercial: HOPD $1,100 vs. office $377 (292% higher)
9. Colonoscopy with lesion removal (CPT 45385):
- Medicare: HOPD $1,373 vs. ASC $860 (160% higher)
- Commercial: HOPD $3,428 vs. ASC $1,080 (219% higher)
10. In cardiology, private equity-affiliated physicians used lower-cost sites in 72% of cases compared to 34% for hospital-affiliated. In gastroenterology, PE physicians used the lower-cost sites in 62% compared to 26% for hospital-affiliated.
