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Updated as of May 22, 2019
Of all the ways hospital and care facility leaders can lower costs and improve care, one of the most promising is the continued shift toward outpatient services. Made possible by medical advances, regulatory changes, and patient management tools, the growth of healthcare delivery outside the hospital has led to lower costs, better outcomes, and higher patient satisfaction in several clinical areas, including surgery.
While most hospitals offer outpatient surgery, ambulatory surgery centers (ASCs) are often praised as superior choices for certain procedures, because of facility efficiencies, lowered risk of hospital-acquired infections, and greater regulatory controls for reimbursements under the outpatient prospective payment system.
Several studies have indicated that ASCs save more money than hospitals. One study from the Journal of the American Academy of Orthopaedic Surgeons found direct cost savings of 17 to 43 percent for various pediatric orthopedic procedures performed at ASCs. Roughly 80 percent of the cost savings are related to time spent in the operating room. Time savings were attributed to surgical factors (73 percent of cases) and anesthetic factors (27 percent of cases).
Another study conducted by Healthcare Blue Book, HealthSmart, and the Ambulatory Surgery Center Association suggested that a full migration of patients from hospital settings to ASCs for specific procedures could save as much as $38 billion a year. While the figure depends upon several assumptions about ASC capacity growth, patient preference, and market price adjustments, a review of data from Definitive Healthcare confirms that many of the top procedures at surgery centers are reimbursed less compared to hospitals.
|1.||66984||Cataract surg w/iol 1 stage||911,754|
|2.||43239||Egd biopsy single/multiple||782,955|
|3.||45380||Colonoscopy and biopsy||685,215|
|4.||45385||Colonoscopy w/lesion removal||513,228|
|5.||20610||Drain/injection in joint/bursa w/o us||504,989|
|8.||67028||Injection eye drug||245,923|
|9.||64483||Injection foramen epidural l/s||208,527|
|10.||66821||After cataract laser surgery||195,290|
Fig 1 Data from Definitive Healthcare’s platform on commercial claims analytics. Outpatient surgical procedure volumes at ASCs are from CY 2018.
|2.||43239||Egd biopsy single/multiple||792,122|
|3.||59025||Fetal non-stress test||705,127|
|4.||45380||Colonoscopy and biopsy||612,751|
|5.||11042||Deb subq tissue 20 sq cm/<||504,178|
|6.||45385||Colonoscopy w/lesion removal||446,709|
|7.||20610||Drain/inj joint/bursa w/o us||385,366|
|8.||12001||Repair of superficial wound: scalp, neck, genitalia, trunk, extremities; 2.5cm/<||378,761|
|10.||36416||Capillary blood draw||318,037|
Fig 2 Data from Definitive Healthcare’s platform on commercial claims analytics. Outpatient surgical procedure volumes at hospitals are from CY 2018.
Definitive Healthcare data shows that cataract surgeries, colonoscopies, and injections are the most common all-payor procedures at ASCs by volume. Colonoscopies and epidural injections are consistent with the role of ASCs, which are ideal for quick diagnostic procedures and treatments for chronic conditions not requiring hospitalization.
Figures for ASC procedures have also been relatively consistent over time. According to a 2011 HHS report to Congress, cataract surgeries with intraocular implant, GI endoscopies with biopsy, and colonoscopies with biopsy were still the top three most-performed operations at ASCs in 2009.
Similarly, the top outpatient procedures at hospitals include colonoscopies and injections or blood draws, but also wound repair and debridement. Notably, cataract surgeries are absent from the list of hospital procedures.
Tissue debridement and wound compression system applications are primarily related to wound care, a field more commonly associated with hospitals than ASCs. Aspiration/injection of joint and insertion of temporary bladder catheter are usually procedures related to hospitalizations, such as severe gout and complex urinary surgery, respectively.
|1.||66984||Cataract surg w/iol 1 stage||$2,612,061,858|
|2.||43239||Esophagogastroduodenoscopy biopsy single/multiple||$1,290,402,672|
|3.||45380||Colonoscopy and biopsy||$1,220,958,306|
|4.||45385||Colonoscopy w/lesion removal||$878,155,578|
|6.||64483||Injection foramen epidural l/s||$398,608,388|
|8.||27447||Total knee arthroplasty||$347,490,853|
|9.||64721||Carpal tunnel surgery||$316,187,182|
|10.||64493||Injection paravertebral facet joint lumbar/sacral spine 1 lev||$295,193,844|
Fig 3 Data from Definitive Healthcare’s platform on commercial claims analytics. Outpatient surgical procedure charges at ASCs are from CY 2018.
|1.||43239||Esophagogastroduodenoscopy biopsy single/multiple||$1,655,114,983|
|2.||45380||Colonoscopy and biopsy||$1,395,640,481|
|4.||66984||Cataract surg w/iol 1 stage||$1,047,422,673|
|5.||45385||Colonoscopy w/lesion removal||$1,034,709,380|
|9.||33249||Insj/rplcmt defib w/lead(s)||$540,553,361|
Fig 4 Data from Definitive Healthcare’s platform on commercial claims analytics. Outpatient surgical procedure charges at hospitals are from CY 2018.
For both hospitals and ASCs, colonoscopies and biopsies made the list of top procedures by total charges, as well as cataract procedures with intraocular implants. One notable difference is the presence of joint surgeries on the list of ASC procedures like total knee arthroscopy and arthroplasty as well as carpal tunnel surgery. This is in line with the function of surgery centers as options for simple procedures patients can recover from at home. Joint replacements are the poster procedure for ASCs.
Additionally, the hospital list includes laparoscopic hysterectomy, a procedure that does not appear on the list for ASCs. Hysterectomies are considered more complicated procedures that could require a patient to stay overnight. Due to the safety risks of a hysterectomy, the procedure is better suited to a hospital outpatient department with an option for hospitalization if necessary.
Cataract surgeries with IOL implants (HCPCS 66984), colonoscopies with lesion removal (HCPCS 45385), pacemaker insertion (HCPCS 00530), and spine epidural injection lumbar sacral (HCPCS 64483) cost on average $1,285, $605, $213 and $94 less, respectively, when performed at ASCs rather than hospital outpatient surgical departments. Even for complex procedures involving implants, such as insertion and replacement of defibrillators (HCPCS 33249), are less expensive at ASCs ($21,456) than at hospitals ($25,446). According to historic data from Definitive Healthcare, in 2014 ASCs charged $3,800 more for these procedures than hospitals on average.
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