HOPDs charge nearly 60% more for surgeries than outpatient surgery centers and clinics.according to claims data analyzed by Blue Health Intelligence. ®
Washington, September 14, 2023 /PRNewswire/ — Costs were significantly higher when common medical procedures were performed in a hospital outpatient department (HOPD) rather than a doctor’s office, according to a study national analysis Tens of millions of claims. An analysis published by the Blue Cross Blue Shield Association (BCBSA) found that the cost of popular tests such as mammography and colonoscopy was consistently higher when performed in the HOPD setting, with up to % was also shown to be high. These rising hospital prices mean higher costs for consumers.
To explore cost disparities in different healthcare facilities, use Blue Health Intelligence® analyzed anonymized claims data for six common routine outpatient procedures for 133 million Blue Cross and Blue Shield members from 2017 to 2022.
Our findings show that not only do HOPDs charge more for the exact same services, but they also charge more than clinics and ambulatory surgery centers (ASCs) where patients receive outpatient diagnostic procedures and outpatient surgical care. This shows that prices are increasing faster each year.
Here are the 2022 price differences for common steps based on configuration:
- The cost of a mammogram at HOPD is 32% higher than at a doctor’s office.
- Colonoscopies cost 32% more at HOPDs than ASCs and twice as much as when done in a doctor’s office.
- Diagnostic costs for colonoscopies are 58% higher at HOPDs than at ASCs and more than twice as expensive when performed in a doctor’s office.
- Cataract surgery costs 56% more at HOPD than at ASC.
- The cost of ear myringotomy at HOPD is 52% higher than when performed at an ASC.
- Consultations cost 31% more in a HOPD setting than in a doctor’s office.
and Approximately 40 million mammogram and Over 15 million Colonoscopies are scheduled to be performed in 2022, and implementing a facility-neutral payment policy would lead to significant savings.
This data is consistent with previous studies.a study by University of California, Berkeley Prices paid by HOPD’s Blue Cross Blue Shield plans in 2019 were twice the price paid in the clinic for biologics, chemotherapy, and other injectable cancer drugs, up from 99% It was 104% higher, and 68% higher with injectable hormone therapy, the researchers found.
moreover, 2016 survey According to a paper in the American Journal of Managed Care, prices for seven common services are significantly higher in HOPDs than in doctor’s offices, ranging from 21% more for a consultation to 258% more for a chest x-ray. There is a width.
“The cost of a procedure should not be determined by the setting in which care is provided,” said BCBSA Senior Vice President of Policy and Advocacy. david merritt. “It is common sense to lower treatment costs, regardless of the location. analysis Site-neutral laws show they can nearly save patients, businesses, and taxpayers $500 billion Over 10 years. We look forward to continuing to work with Congress to protect patients from these high costs. ”
One of the main drivers of these cost differences is the acquisition of physician practices by corporate health systems over the past two decades. as a result These physician practices are converted to HOPDs, which incurs additional facility fees and increases overall prices.Additionally, Medicare pays more for services provided in HOPDs than if the same services were provided in other medical settings outside of hospitals, increasing costs for both patients and Medicare. Masu hundreds of millions of dollars.
BCBSA supports bipartisan legislation in the U.S. House of Representatives and the U.S. Senate to enact fair hospital billing policies. kevin hahn (R-OK) And Annie Kuster’s (D-NH) FAIR Act and Sen. maggie hassan (D-NH) and mike brown’s (R-IN) Site Law.
Additionally, earlier this year, BCBSA Affordable solutions for America’s healtha comprehensive set of proposals that can reduce health care costs for patients, consumers, and taxpayers. $767 billion Over 10 years. This will expand site-neutral payments for outpatient services, improve competition, increase access to low-cost prescription drugs, and ensure patients receive quality care at the right place and time. It can be achieved.
“Blue Cross Blue Shield Association is committed to building a more affordable, fair, and better health care system. These common-sense solutions address the root causes of rising health care costs and help patients We prioritize the needs of the people,” Merritt continued.
About Blue Cross Blue Shield Association
The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health insurance coverage to one in three Americans. We offer
Source: Blue Cross Blue Shield Association
