Sep 14, 2023 - Health

New data shows price hikes for common medical procedures

Data: Blue Health Intelligence; Chart: Axios Visuals

Colonoscopies can cost up to nearly 60% more when performed in a hospital compared to an ambulatory surgery center, according to a new analysis from a Blue Cross Blue Shield Association subsidiary.

Why it matters: The report draws on claims data for 133 million Blues members from 2017 through 2022 and underscores insurers' arguments for site-neutral policies that pay the same for some services, regardless of the setting.

  • Paying more for services that can be delivered in a less-intensive setting could result in higher insurance premiums and more out-of-pocket costs for consumers, they say.

By the numbers: The allowed cost, or the negotiated price, for a routine colonoscopy screening was $1,124 on average in hospital outpatient departments, 32% higher than the $925 allowed in ambulatory surgery centers last year.

  • The allowed cost for a diagnostic colonoscopy to investigate abnormal symptoms was $1,646 on average in outpatient departments in 2022, 58% higher than the $1,040 allowed in ambulatory surgery centers.
  • When it came to mammography, the allowed cost was $287 in hospitals, 32% higher than the $217 allowed in doctors' offices.
  • For cataract surgery, the allowed cost in outpatient departments was $3,499 in 2022, 56% higher than the $2,304 allowed in an ambulatory surgery center.

Between the lines: In the case of both the routine screening colonoscopy and the diagnostic colonoscopy, the cost of certain procedures wasn't only higher in hospital outpatient settings each year included in the analysis, but generally rose faster in their costs over time.

Reality check: The analysis focuses only on a cohort of handpicked procedures and may not reflect the broader landscape.

  • But with the amount of claims data it draws from, it helps paint a clearer picture of why health care interests are trying to influence the site-neutral debate in Congress this year.
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