Out-of-network ASCs have lower costs than in-network hospital outpatient departments, according to a new 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. Researchers examined how prices varied by site of care (ASC vs. HOPD) and network status (in-network vs. out-of-network).
Here are five things to know:
1. Across all analyses, ASCs offered significantly lower prices, with in-network ASCs having the lowest average costs. Even out-of-network ASCs remained cheaper than in-network HOPDs across all four procedure types.
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. Patients paid the least at in-network facilities. 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 rose sharply outside 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.
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.