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
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.
Estimating Surprise Bills Among Members of Commercial Health Insurance
Potential surprise bills occurred for 1.8 percent of members and 6.2 percent of episodes in 2018. Emergency episodes had a higher rate of potential surprise bills than non-emergency care.
Provider-Plan Partnership Models Enable High-Value Care
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.