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Top Outpatient Procedures at Hospitals vs Surgery Centers

September 4, 2018 BY Alanna Moriarty

Top Outpatient Procedures at Hospitals vs Surgery Centers

 

The continual shift from inpatient to outpatient procedures is one of the most common ways hospitals and care facilities reduce healthcare spending. This is especially cost-effective when patients seek outpatient care at a clinic or ambulatory surgery center (ASC) rather than a traditional hospital. Because services are often limited at ASCs and outpatient clinics, these facilities are able to charge less than hospitals, whose charges must cover operating costs of a wide breadth of services and staff. 

Major influencing factors in the shift to outpatient facilities and services include advances in surgical technology, improved outcomes via regulatory changes, edits to the Centers for Medicare and Medicaid Services (CMS) inpatient-only procedure list, and others.

Below, we've compiled list of the top 10 outpatient medical procedures at U.S. hospitals and ASCs for comparison.

Top 10 Hospital Outpatient Procedures by Volume

Rank HCPS/CPT Code Description Number of Procedures
1. 36415 Routine venipuncture  109,135,527  
2. 85025 Complete blood count w/ differential white blood cell count 95,558,886  
3. 80053 Comprehensive metabolic panel 84,921,692  
4. 97110 Therapeutic exercises 43,649,139  
5. 80048 Metabolic panel total ca 37,665,909  
6. 81001 Urinalysis auto w/scope 34,599,001  
7. 93005 Electrocardiogram tracing 31,152,864  
8. J2704 Injection of propofol, 10 mg 30,741,722  
9. 84443 Assay thyroid stimulating hormone 28,824,273  
10. 80061 Lipid panel 28,364,039  

Fig 1 Data from Definitive Healthcare based on 2017 Medicare and all-payor procedure estimates. Does not include visits to emergency departments or clinics.

Of the top 10 outpatient medical procedures at hospitals, seven are diagnostic tests and one is a precursor to anesthesia. The only two treatments present are "therapeutic exercises" and "assay thyroid stimulating hormone." Unlike at ASCs, patients often visit primary care physicians or urgent care clinics at hospitals for diagnoses rather than procedures and treatments. Patients are tested and receive diagnoses at hospitals before selecting where to undergo a procedure or other treatment.

Top 10 ASC Outpatient Procedures

Rank HCPS Code Description Number of Procedures
1. 66984 Cataract surg w/ intraocular implant, 1 stage 1,226,120  
2. G0500 Moderate sedation for endoscopy service for patient under 5yrs 778,345  
3. 99153 Moderate sedation by the same physician performing the procedure 760,462  
4. J0585 Injection, onabotulinumtoxinA (Botox) 569,325  
5. 43239 Esophagogastroduodenoscopy (Egd) biopsy single/multiple 541,547  
6. 45380 Colonoscopy and biopsy 451,144  
7. 45385 Colonoscopy w/lesion removal 377,657  
8. 64483 Epidural steroid injection in lumbar spine w/ imagine guidance 309,848  
9. 66821 After cataract laser surgery 283,480  
10. 64493 Injection into lumbar/sacral spine w/ image guidance 208,145  

Fig 2 Data from Definitive Healthcare based on 2016 Medicare and all-payor procedure estimates. Does not include visits to emergency departments or clinics. 

Unlike the top outpatient procedures at hospitals, only two diagnostic tests are present on the list of top ASC procedures. Cataract surgeries are by far the most common ASC procedure with over 1.2 million claims in 2016, with sedation taking the next two spots. There are no reports of "routine venipunctures" or other diagnostic panels at ASCs, which notably make up the majority of hospital outpatient procedures. The ability of ASCs to focus solely on treatments rather than diagnostics means these facilities are likely able to charge patients less than hospitals for the same procedures, as ASCs have no lab fees or other related costs to cover.

To read more about the effects of ASCs and outpatient centers on care coordination, visit the Definitive Blog or download a Definitive List!

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