Comparing Outpatient Sites of Service for Gastrointestinal Procedures
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.
Related Public Policy Research
Infusion Therapy Quality and Cost Outcomes by Site of Care
Individuals receiving infusion therapy in hospital outpatient departments (HOPD) experienced substantially higher costs without better outcomes compared with alternative sites of care. This study found similar rates of adverse events, utilization, and adherence across sites, while outpatient costs were more than 40% higher in HOPD settings.
Hospital Characteristics and Medicaid Hospital Prices
The cost of hospital care in the U.S. continues to be a central concern for health insurers, employers, and policymakers alike. This analysis found that Medicaid facility prices for several routine children’s procedures were significantly higher at children’s hospitals, critical access hospitals, and system-affiliated hospitals.
Costs and Quality After Independent Hospitals Are Acquired by Health Systems
Hospital acquisitions have consolidated care in fewer and larger health systems. Independent hospital mergers have exposed consumers, employers, and other payers to higher prices without a commensurate increase in quality of or access to hospital care.