Shifting common outpatient procedures to ASCs shows cost savings

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Hospital outpatient departments perform routine procedures and surgeries such as colonoscopies and cataract removals for commercially insured individuals at substantially higher prices than Ambulatory Surgery Centers, according to new findings published by UnitedHealth Group.

Shifting outpatient procedures for non-complex commercially insured individuals to ASCs would reduce spending by 59% and save consumers $684 on average per outpatient procedure, the data showed.

WHAT'S THE IMPACT?

The average price of common procedures performed in a hospital outpatient department in 2019 was $7,716 –144% more than the average price of the same procedures performed in ASCs, with the data showing that ASC costs tend to hover around $3,160.

Of the more than 6 million routine outpatient procedures performed in hospital outpatient departments, only 10% of procedures are for complex patients, such as those with morbid obesity or those suffering from end stage renal disease, data showed. 

On top of that, 35% of procedures are for patients who do not have an ASC near their homes. Fifty-six percent of procedures are for non-complex patients and can be performed at ASCs within a short distance of the patient's home.

Shifting common outpatient procedures for non-complex, commercially insured individuals to ASCs would reduce the cost of procedures by an average of 59%, according to UHG. 

With commercially insured patients responsible for about 15% of the cost of outpatient procedures, shifting these procedures to ASCs would save consumers $684 on average per procedure.

THE LARGER TREND

While ASCs hold promise to reduce costs, a 2019 Leapfrog Group report showed that there are gaps in the education, training and national certifications of clinicians in both ASCs and hospital outpatient departments.

Both ASCs and HOPDs showed gaps in ensuring all providers performing surgery or anesthesia were board certified, the report found. And while nearly all ASCs and HOPDs always have a clinician present who is certified in Advanced Cardiovascular Life Support (ACLS) and can perform life-saving actions if complications arise, fewer facilities have clinicians certified in Pediatric Advanced Life Support (PALS).

Parents, the report said, should be aware of this gap and ensure the facility they choose for their child's care has PALS-certified clinicians prior to scheduling a procedure.

In 2020, the Centers for Medicare and Medicaid Services proposed a 2.6% payment increase for ASCs in an update to the Outpatient Prospective Payment System. The move was meant to help promote site neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower-cost ASC setting.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com