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.
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