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.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.