Common procedures can double in cost when performed at an HOPD vs. ASC, BCBS data shows

Common medical procedures can cost more than twice as much when they take place in a hospital outpatient setting compared to a physician office or ambulatory surgery center, according to an analysis published Sept. 14 by the Blue Cross Blue Shield Association.

"Our findings suggest that if commercial payers implemented site-neutral payments across settings, then employers, employees, and patients would realize substantial savings through lower premiums and out-of-pocket costs." 

The new research comes alongside a policy push from the BCBSA in favor of site-neutral payment reform under Medicare, which would require providers to bill for services uniformly across all facilities. In arguments against site-neutral payments, the AHA has said they fail to take into account key differences between hospital outpatient centers and other sites of care such as more restrictive licensing and regulatory requirements. 

For the analysis, the association of 34 independent BCBS affiliates used claims data for six common outpatient procedures across 133 million BCBS members from 2017 to 2022. The six procedures are cataract surgery, chest x-ray, clinic visits, colonoscopy (diagnostic and screening), ear tympanostomy and mammography. Office visits were evaluated from 2014 to 2022.  

"Findings show that not only were HOPDs charging more for the exact same service, but prices also increased faster each year compared to charges at physician offices and ambulatory surgery centers, where patients receive outpatient diagnostic procedures as well as outpatient surgical care," the association wrote.

Six key findings:

  1. Mammograms cost 32 percent more in a hospital than in a physician's office.  

  2. Colonoscopy screenings cost 32 percent more in a hospital than in an ASC and 50 percent more in a physician's office.  

  3. Diagnostic colonoscopies cost 58 percent more in a hospital than in an ASC and more than double the cost compared to a physician's office. 

  4. Cataract surgery costs 56 percent more in a hospital than in an ASC. 

  5. Ear tympanostomies cost 52 percent more in a hospital than in an ASC. |

  6. Clinical visits cost 31 percent more in a hospital than in a physician's office.  

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