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Top 10 Outpatient Procedures at ASCs and Hospitals

Of all the ways the healthcare industry as a whole can lower costs and improve care, one of the most promising is the continued shift to outpatient services. Made possible by medical advances, regulatory changes, and better patient management, 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 are often praised as a superior choice for certain procedures, both because of facility efficiencies and greater regulatory controls for reimbursements under the outpatient prospective payment system.

One recent 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 ASCs are reimbursed less compared to hospitals. Cataract surgeries with IOL implants, GI endoscopies, colonoscopies with lesion removal, and spine epidural injection lumbar sacral cost roughly $220, $110, $170, and $120 less, respectively, when performed at ASCs rather than hospital outpatient surgical departments. The relationship doesn’t hold true for all procedures, however, as ASCs tend to charge substantially more than hospital for certain operations, such as those involving medical implants like pacemakers or defibrillators. Definitive Healthcare data indicates that ASCs charge as much as $3,800 more on average for defibrillator insertion or replacement, for instance.

The following is a look at the outpatient surgical procedures billed to Medicare with the highest procedure volume (based on 2014 data, the latest available).

Top 10 Outpatient Procedures by Volume at ASCs

Description HCPCS/CPT Code Number of Procedures Total Payments (M) Avg Payment/Claim
Cataract surgery with IOL implant 66984 1,155,283 $1,108.0 $959
Esophagogastroduodenoscopy with biopsy 43239 524,082 $157.9 $301
Colonoscopy and biopsy 45380 416,218 $146.6 $352
Colonoscopy with lesion removal 45385 331,565 $132.8 $401
Spine epidural injection foraminal 64483 282,962 $94.7 $335
Post-laser cataract surgery capsulotomy 66821 275,760 $62.7 $227
Spine epidural injection lumbar, sacral 62311 210,159 $75.2 $358
Injection, paravertebral facet joint 64493 174,450 $53.4 $306
Diagnostic colonoscopy 45378 157,951 $63.3 $401
Colorectal screening, high-risk individual G0105 128,181 $42.7 $333

 

Top 10 Outpatient Procedures by Volume at Hospitals*

Description HCPCS/CPT Code Number of Procedures Total Payments (M) Avg Payment/Claim
Subcutaneous tissue debridement 11042 841,517 $179.6 $213
Esophagogastroduodenoscopy with biopsy 43239 628,900 $258.6 $411
Aspiration/injection of joint 20610 578,407 $81.4 $141
Cataract surgery with IOL implant 66984 512,191 $603.6 $1,178
Colonoscopy and biopsy 45380 472,886 $247.6 $524
Colonoscopy with lesion removal 45385 350,001 $147.4 $421
Spine epidural injection lumbar, sacral 62311 326,956 $156.2 $478
Insertion of temporary bladder catheter 51702 308,614 $21.3 $69
Application of multi-layer venous wound compression system 29581 303,026 $29.4 $97
Diagnostic colonoscopy 45378 253,350 $126.9 $501

*Ranking does not include CPT procedures categorized as surgeries that cannot receive Medicare reimbursement at ASCs

Definitive Healthcare data shows that endoscopic procedures, cataract surgeries, and epidural injections are the most common Medicare procedures at ASCs by volume. Endoscopies 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 report HHS report to Congress, cataract surgeries with IOL implant, GI endoscopies with biopsy, and colonoscopies with biopsy were still the top three most-performed operations at ASCs in 2009.

When discounting outpatient procedures not performed at ASCs, such as blood draws and transfusions, the top operations at hospitals also consist primarily of endoscopies. Key exceptions are subcutaneous tissue debridement, aspiration/injection of joint, insertion of temporary bladder catheter, and application of multi-layer venous wound compression system 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.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and numerous other healthcare providers. It includes extensive analytics capabilities for inpatient and outpatient diagnoses and procedures at hospitals and ASCs.

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