Comparing Outpatient Sites of Service for Gastrointestinal Procedures

July 2020
Full report

Over the next decade, the U.S. healthcare system could realize savings of approximately $12 billion if 1-in-5 upper gastrointestinal (GI) and colonoscopy procedures were performed in ambulatory surgery centers (ASCs) rather than in hospital outpatient departments (HOPDs).

Advances in medical technology have allowed many more procedures to be safely performed in outpatient settings–mainly ASCs and HOPDs. Research demonstrates that ASCs offer equivalent quality of care and comparable outcomes as HOPDs. Further, they may offer greater convenience and lower costs for consumers.

To illustrate the opportunities for consumers and the healthcare system, this analysis examines claims data from individuals enrolled in Elevance Health’s affiliated commercial health plans in 14 states. A large majority of upper GI and colonoscopy procedures performed in a HOPD in 2019 were in counties where an ASC also offered these services. On average HOPD costs were 1.7 times greater than those of an ASC.

Topics

  • Quality and patient experience at ASCs and HOPDs
  • Efficiency and costs of ASCs and HOPDs
  • Opportunities for consumers and the healthcare system

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Partnerships between health plans and high-value providers are a promising solution to reduce low-value care, a form of waste that contributes to the growing cost of healthcare in the U.S.

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