5 numbers on HOPD vs. ASC reimbursements

As more procedures gain approval to be conducted on an outpatient basis, reimbursement differences between various care settings have gained significant attention in the healthcare industry — among patients, executives and clinicians alike. 

Below are five numbers highlighting reimbursement differences between hospital outpatient departments and ASCs.

58%: The percentage more procedures done in HOPDs can cost compared to a physician's office or ASC, according to a 2023 analysis by Blue Health Intelligence, the Blue Cross Blue Shield Association's data analytics company.

70%: The percentage Medicare hospital pay increased from 2001 to 2023. By contrast, Medicare physician payment has only increased by 9% in the same period, according to a report by the American Medical Association. 

26%: The percentage Medicare physician pay has declined when adjusting for inflation from 2001 to 2023, according to the AMA.

$1,711: The national average cost of an excision of cataract with removal of lens, without ECP procedure at an ASCs, according to Medicare's procedure price lookup tool. The same procedure costs an average of $2,748 at HOPDs.

55%: The percent that facility fees for colonoscopy procedures covered by private health insurance are at hospitals compared to those at ASCs as of May 2023, according to a Johns Hopkins Bloomberg School of Public Health study published in JAMA Health Forum.

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