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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 Code | Description | Number of Claims | Total Charges (M) | Explore This Dataset | |
| 1. | J2505 | Injection, pegfilgrastim 6mg | 98,784 | $1,878,198,021 | Explore This Profile |
| 2. | J1745 | Infliximab not biosimil 10mg | 88,350 | $1,660,371,735 | Explore This Profile |
| 3. | J9271 | Inj pembrolizumab | 49,504 | $1,637,558,943 | Explore This Profile |
| 4. | J9299 | Injection, nivolumab | 67,191 | $1,530,111,129 | Explore This Profile |
| 5. | J9310 | Rituximab injection | 70,725 | $1,489,744,684 | Explore This Profile |
| 6. | J9355 | Trastuzumab injection | 96,063 | $1,216,398,366 | Explore This Profile |
| 7. | J9035 | Bevacizumab injection | 86,907 | $1,128,099,707 | Explore This Profile |
| 8. | J2350 | Injection, ocrelizumab, 1 mg | 9,259 | $721,851,899 | Explore This Profile |
| 9. | J0897 | Denosumab injection | 111,158 | $674,720,112 | Explore This Profile |
| 10. | J9306 | Injection, pertuzumab, 1 mg | 27,488 | $510,882,145 | Explore This Profile |
| 11. | J9305 | Pemetrexed injection | 32,553 | $494,326,711 | Explore This Profile |
| 12. | J1561 | Gamunex-C/Gammaked | 37,613 | $490,247,468 | Explore This Profile |
| 13. | J1300 | Eculizumab injection | 5,613 | $477,672,638 | Explore This Profile |
| 14. | J9145 | Injection, daratumumab 10 mg | 26,595 | $472,812,529 | Explore This Profile |
| 15. | J2323 | Natalizumab injection | 24,365 | $466,278,688 | Explore This Profile |
| 16. | J1459 | Inj IVIG privigen 500 mg | 40,561 | $452,668,490 | Explore This Profile |
| 17. | J3380 | Injection, vedolizumab | 21,199 | $427,134,123 | Explore This Profile |
| 18. | J9041 | Bortezomib injection | 92,502 | $365,922,407 | Explore This Profile |
| 19. | J1569 | Gammagard liquid injection | 28,840 | $359,246,077 | Explore This Profile |
| 20. | J2353 | Octreotide injection, depot | 18,198 | $350,398,825 | Explore This Profile |
| 21. | J9228 | Ipilimumab injection | 5,390 | $346,157,039 | Explore This Profile |
| 22. | J9217 | Leuprolide acetate suspnsion | 38,763 | $307,552,214 | Explore This Profile |
| 23. | J2785 | Regadenoson injection | 255,662 | $297,920,091 | Explore This Profile |
| 24. | J9264 | Paclitaxel protein bound | 39,436 | $290,972,674 | Explore This Profile |
| 25. | J7030 | Normal saline solution infus | 2,426,162 | $282,341,781 | Explore This Profile |
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
Definitive's Healthcare Insights are developed with data from the Definitive Healthcare platform. Want even more insights? Start a Free Trial now and get access to the highest quality data and intelligence on hospitals, physicians, and other healthcare providers.
| HCPCS Code | Description | Number of Claims | Total Charges | Explore This Dataset | |
| 1. | J2405 | Ondansetron hcl injection | 4,003,701 | $228,998,082 | Explore This Profile |
| 2. | J3010 | Fentanyl citrate injection | 3,142,635 | $162,315,232 | Explore This Profile |
| 3. | J1885 | Ketorolac tromethamine inj | 2,693,737 | $126,373,323 | Explore This Profile |
| 4. | J2250 | Inj midazolam hydrochloride | 2,505,806 | $105,667,487 | Explore This Profile |
| 5. | J7030 | Normal saline solution infus | 2,426,162 | $282,341,781 | Explore This Profile |
| 6. | J2704 | Inj, propofol, 10 mg | 2,332,395 | $193,585,118 | Explore This Profile |
| 7. | J1100 | Dexamethasone sodium phos | 2,214,976 | $98,277,324 | Explore This Profile |
| 8. | J3490 | Drugs unclassified injection | 2,189,170 | $192,046,833 | Explore This Profile |
| 9. | J7120 | Ringers lactate infusion | 1,443,615 | $164,242,651 | Explore This Profile |
| 10. | J2270 | Morphine sulfate injection | 1,395,855 | $77,410,968 | Explore This Profile |
| 11. | J0690 | Cefazolin sodium injection | 1,342,509 | $128,716,380 | Explore This Profile |
| 12. | J1170 | Hydromorphone injection | 1,003,220 | $63,385,903 | Explore This Profile |
| 13. | J7050 | Normal saline solution infus | 986,637 | $86,663,827 | Explore This Profile |
| 14. | J1644 | Inj heparin sodium per 1000u | 983,135 | $74,216,942 | Explore This Profile |
| 15. | J1200 | Diphenhydramine hcl injectio | 923,895 | $30,765,247 | Explore This Profile |
| 16. | J2001 | Lidocaine injection | 913,434 | $26,675,902 | Explore This Profile |
| 17. | J0696 | Ceftriaxone sodium injection | 898,979 | $111,364,693 | Explore This Profile |
| 18. | J7040 | Normal saline solution infus | 644,132 | $49,475,147 | Explore This Profile |
| 19. | J1642 | Inj heparin sodium per 10 u | 639,729 | $25,381,891 | Explore This Profile |
| 20. | J1650 | Inj enoxaparin sodium | 570,650 | $81,302,520 | Explore This Profile |
| 21. | J2765 | Metoclopramide hcl injection | 500,094 | $18,348,310 | Explore This Profile |
| 22. | J2930 | Methylprednisolone injection | 449,666 | $36,448,626 | Explore This Profile |
| 23. | J2060 | Lorazepam injection | 440,864 | $20,557,450 | Explore This Profile |
| 24. | J0131 | Acetaminophen injection | 386,475 | $91,983,634 | Explore This Profile |
| 25. | J1815 | Insulin injection | 350,228 | $33,425,956 | Explore This Profile |
Fig 2. Data from Definitive Healthcare based on all-payor commercial claims analytics from CY 2018.