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.
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.
