An analysis released by the Blue Cross Blue Shield Association (BCBSA) shows the costs for prevalent procedures like mammograms or colonoscopies were consistently higher — as much as 58% more expensive — when performed in HOPD settings. Higher hospital prices mean higher costs to consumers. The analysis looked at claims data for six common, everyday outpatient procedures, covering 133 million Blue Cross and Blue Shield members from 2017 through 2022 and found the following:
- Mammograms cost 32% more in an HOPD than in a doctor’s office.
- Colonoscopy screenings cost 32% more in an HOPD than in an ASC and double the cost compared to when performed in a doctor’s office.
- Diagnostic colonoscopies cost 58% more in an HOPD than in an ASC and more than double the cost compared to when performed in a doctor’s office.
- Cataract surgery costs 56% more in an HOPD than in an ASC.
- Ear tympanostomies cost 52% more in an HOPD than when performed in an ASC.
- Clinical visits cost 31% more in an HOPD setting than in a doctor’s office.
BCBSA notes, “One key driver of these cost differences is the acquisition of physician practices by corporate health systems over the past 20 years, which has resulted in those physician practices being converted into HOPDs, thereby generating additional facility fees and higher prices overall. Furthermore, Medicare pays more for services provided in HOPDs than it does when the same services are provided in other care settings outside of the hospital, costing both patients and Medicare hundreds of millions of dollars.”
Read the full analysis here.