How HOPD costs compare to ASCs

For the research, BCBSA looked at PPO commercial claims data for roughly 133 million people between 2017 and 2022, or between 2014 and 2022 for office visits. The researchers specifically looked at six procedures:

• Cataract surgery
• Chest X-ray
• Clinic visits
• Colonoscopy (diagnostic and screening)
• Ear tympanostomy
• Mammography

They found that allowed costs at HOPDs, other than clinical visits, over the course of six years were not only higher than at ASCs, but also grew faster.

For example, diagnostic colonoscopies were 58% more expensive in an HOPD than in an ASC, while mammograms were 32% more expensive in an HOPD than in an ASC.

Discussion

According to the researchers, the findings suggest "that if commercial payers implemented site-neutral payments across settings, then employers, employees, and patients would realize substantial savings through lower premiums and out-of-pocket costs."

As for why costs at HOPDs were higher than ASCs, the researchers said they weren't sure, but listed a few potential reasons.

"These include market forces resulting from physician and hospital consolidation, hospitals passing on the higher costs of delivering care regardless of settings, the financial impact of COVID-19 on providers and insurers, and variation in severity of illness across settings," they wrote. "Future studies will address the root cause of these pricing differences and other questions."

David Merritt, SVP of policy and advocacy for BCBSA, said in a statement that "lowering the cost of care, regardless of the site, is common sense. Our analysis shows site-neutral legislation could save our patients, businesses and taxpayers nearly $500 billion over 10 years. We look forward to continuing our work with Congress to protect patients from these higher costs." (Diamond, Fierce Healthcare, 9/14; Reed, Axios, 9/14)

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