Accelerate Your Growth

Power your team with the highest quality, daily updated intelligence on hospitals, physicians, and other healthcare providers

There is a growing emphasis on outpatient care in the United States. Outpatient care facilities play an important role in reducing healthcare costs while also satisfying patient desires for convenient, quality care. New technologies and changing guidelines from the Centers for Medicaid and Medicare Services (CMS) have incentivised this shift in focus from inpatient to outpatient services.

Ambulatory surgery centers (ASCs) pose another challenge for hospital outpatient departments. Though ASCs only get reimbursed at 60 percent the rate of hospitals, some patients consider them a more convenient alternative to traditional settings. ASCs can have shorter wait times for surgeries, and can also be more flexible in bundling certain procedures. The procedures themselves may also take less time at an ASC than at a hospital outpatient facility. Some hospital leaders have chosen to avoid this direct conflict by acquiring, building, or partnering with ASCs. This keeps patients in-network, stemming revenue loss.

Outpatient services have become a greater source of hospital revenue in the past 20 years. In the 1990s, outpatient care services constituted between 10 and 15 percent of a hospital’s income. Now, that average is just over 50 percent according to Definitive Healthcare data.

All five off the top drugs used in outpatient procedures (by total charges), are used in the treatment of cancer, and two are also used to treat autoimmune disorders. All of the top 25 drugs by total payments were administered by injection or infusion. The most-used outpatient drugs by number of claims were much more diverse than the top by charges. Included in the top five drugs are an anti-nausea medication, opioid pain reliever, and anti-inflammatory drug.

Top 25 Drugs Used in Outpatient Procedures by Charges

  HCPCS Code Description Number of Claims Total Charges (M)

1.

J2505

Injection, pegfilgrastim 6mg

98,784

$1,878,198,021

2.

J1745

Infliximab not biosimil 10mg

88,350

$1,660,371,735

3.

J9271

Inj pembrolizumab

49,504

$1,637,558,943

4.

J9299

Injection, nivolumab

67,191

$1,530,111,129

5.

J9310

Rituximab injection

70,725

$1,489,744,684

6.

J9355

Trastuzumab injection

96,063

$1,216,398,366

7.

J9035

Bevacizumab injection

86,907

$1,128,099,707

8.

J2350

Injection, ocrelizumab, 1 mg

9,259

$721,851,899

9.

J0897

Denosumab injection

111,158

$674,720,112

10.

J9306

Injection, pertuzumab, 1 mg

27,488

$510,882,145

11.

J9305

Pemetrexed injection

32,553

$494,326,711

12.

J1561

Gamunex-C/Gammaked

37,613

$490,247,468

13.

J1300

Eculizumab injection

5,613

$477,672,638

14.

J9145

Injection, daratumumab 10 mg

26,595

$472,812,529

15.

J2323

Natalizumab injection

24,365

$466,278,688

16.

J1459

Inj IVIG privigen 500 mg

40,561

$452,668,490

17.

J3380

Injection, vedolizumab

21,199

$427,134,123

18.

J9041

Bortezomib injection

92,502

$365,922,407

19.

J1569

Gammagard liquid injection

28,840

$359,246,077

20.

J2353

Octreotide injection, depot

18,198

$350,398,825

21.

J9228

Ipilimumab injection

5,390

$346,157,039

22.

J9217

Leuprolide acetate suspnsion

38,763

$307,552,214

23.

J2785

Regadenoson injection

255,662

$297,920,091

24.

J9264

Paclitaxel protein bound

39,436

$290,972,674

25.

J7030

Normal saline solution infus

2,426,162

$282,341,781

Fig 1. Data from Definitive Healthcare based on all-payor commercial claims analytics from CY 2018.

 

Top 25 Drugs Used in Outpatient Procedures by Claims

  HCPCS Code Description Number of Claims Total Charges

1.

J2405

Ondansetron hcl injection

4,003,701

$228,998,082

2.

J3010

Fentanyl citrate injection

3,142,635

$162,315,232

3.

J1885

Ketorolac tromethamine inj

2,693,737

$126,373,323

4.

J2250

Inj midazolam hydrochloride

2,505,806

$105,667,487

5.

J7030

Normal saline solution infus

2,426,162

$282,341,781

6.

J2704

Inj, propofol, 10 mg

2,332,395

$193,585,118

7.

J1100

Dexamethasone sodium phos

2,214,976

$98,277,324

8.

J3490

Drugs unclassified injection

2,189,170

$192,046,833

9.

J7120

Ringers lactate infusion

1,443,615

$164,242,651

10.

J2270

Morphine sulfate injection

1,395,855

$77,410,968

11.

J0690

Cefazolin sodium injection

1,342,509

$128,716,380

12.

J1170

Hydromorphone injection

1,003,220

$63,385,903

13.

J7050

Normal saline solution infus

986,637

$86,663,827

14.

J1644

Inj heparin sodium per 1000u

983,135

$74,216,942

15.

J1200

Diphenhydramine hcl injectio

923,895

$30,765,247

16.

J2001

Lidocaine injection

913,434

$26,675,902

17.

J0696

Ceftriaxone sodium injection

898,979

$111,364,693

18.

J7040

Normal saline solution infus

644,132

$49,475,147

19.

J1642

Inj heparin sodium per 10 u

639,729

$25,381,891

20.

J1650

Inj enoxaparin sodium

570,650

$81,302,520

21.

J2765

Metoclopramide hcl injection

500,094

$18,348,310

22.

J2930

Methylprednisolone injection

449,666

$36,448,626

23.

J2060

Lorazepam injection

440,864

$20,557,450

24.

J0131

Acetaminophen injection

386,475

$91,983,634

25.

J1815

Insulin injection

350,228

$33,425,956

Fig 2. Data from Definitive Healthcare based on all-payor commercial claims analytics from CY 2018.