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

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HCPCS CodeDescriptionNumber of ClaimsTotal Charges (M)Explore These Claims
1.J2505Injection, pegfilgrastim 6mg98,784$1,878,198,021Explore This Code
2.J1745Infliximab not biosimil 10mg88,350$1,660,371,735Explore This Code
3.J9271Inj pembrolizumab49,504$1,637,558,943Explore This Code
4.J9299Injection, nivolumab67,191$1,530,111,129Explore This Code
5.J9310Rituximab injection70,725$1,489,744,684Explore This Code
6.J9355Trastuzumab injection96,063$1,216,398,366Explore This Code
7.J9035Bevacizumab injection86,907$1,128,099,707Explore This Code
8.J2350Injection, ocrelizumab, 1 mg9,259$721,851,899Explore This Code
9.J0897Denosumab injection111,158$674,720,112Explore This Code
10.J9306Injection, pertuzumab, 1 mg27,488$510,882,145Explore This Code
11.J9305Pemetrexed injection32,553$494,326,711Explore This Code
12.J1561Gamunex-C/Gammaked37,613$490,247,468Explore This Code
13.J1300Eculizumab injection5,613$477,672,638Explore This Code
14.J9145Injection, daratumumab 10 mg26,595$472,812,529Explore This Code
15.J2323Natalizumab injection24,365$466,278,688Explore This Code
16.J1459Inj IVIG privigen 500 mg40,561$452,668,490Explore This Code
17.J3380Injection, vedolizumab21,199$427,134,123Explore This Code
18.J9041Bortezomib injection92,502$365,922,407Explore This Code
19.J1569Gammagard liquid injection28,840$359,246,077Explore This Code
20.J2353Octreotide injection, depot18,198$350,398,825Explore This Code
21.J9228Ipilimumab injection5,390$346,157,039Explore This Code
22.J9217Leuprolide acetate suspnsion38,763$307,552,214Explore This Code
23.J2785Regadenoson injection255,662$297,920,091Explore This Code
24.J9264Paclitaxel protein bound39,436$290,972,674Explore This Code
25.J7030Normal saline solution infus2,426,162$282,341,781Explore This Code

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

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HCPCS CodeDescriptionNumber of ClaimsTotal ChargesExplore These Claims
1.J2405Ondansetron hcl injection4,003,701$228,998,082 Explore This Code
2.J3010Fentanyl citrate injection3,142,635$162,315,232 Explore This Code
3.J1885Ketorolac tromethamine inj2,693,737$126,373,323 Explore This Code
4.J2250Inj midazolam hydrochloride2,505,806$105,667,487 Explore This Code
5.J7030Normal saline solution infus2,426,162$282,341,781 Explore This Code
6.J2704Inj, propofol, 10 mg2,332,395$193,585,118 Explore This Code
7.J1100Dexamethasone sodium phos2,214,976$98,277,324 Explore This Code
8.J3490Drugs unclassified injection2,189,170$192,046,833 Explore This Code
9.J7120Ringers lactate infusion1,443,615$164,242,651 Explore This Code
10.J2270Morphine sulfate injection1,395,855$77,410,968 Explore This Code
11.J0690Cefazolin sodium injection1,342,509$128,716,380 Explore This Code
12.J1170Hydromorphone injection1,003,220$63,385,903 Explore This Code
13.J7050Normal saline solution infus986,637$86,663,827 Explore This Code
14.J1644Inj heparin sodium per 1000u983,135$74,216,942 Explore This Code
15.J1200Diphenhydramine hcl injectio923,895$30,765,247 Explore This Code
16.J2001Lidocaine injection913,434$26,675,902 Explore This Code
17.J0696Ceftriaxone sodium injection898,979$111,364,693 Explore This Code
18.J7040Normal saline solution infus644,132$49,475,147 Explore This Code
19.J1642Inj heparin sodium per 10 u639,729$25,381,891 Explore This Code
20.J1650Inj enoxaparin sodium570,650$81,302,520 Explore This Code
21.J2765Metoclopramide hcl injection500,094$18,348,310 Explore This Code
22.J2930Methylprednisolone injection449,666$36,448,626 Explore This Code
23.J2060Lorazepam injection440,864$20,557,450 Explore This Code
24.J0131Acetaminophen injection386,475$91,983,634 Explore This Code
25.J1815Insulin injection350,228$33,425,956 Explore This Code

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