Facility fees for colonoscopy nearly 55% more at hospitals vs. ambulatory surgery centers
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Key takeaways:
- Researchers assessed facility fees for three colonoscopy procedures at hospitals and ambulatory surgery centers nationwide.
- Fees were disclosed by Anthem, Cigna, Healthcare Service Corp. and UnitedHealthcare.
Facility fees for three common colonoscopy procedures were approximately 55% higher at hospitals compared with ambulatory surgery centers in the same county and with the same insurer, researchers reported in JAMA Health Forum.
“Variation in facility fees paid for similar health services across different sites of care has received attention,” Yang Wang, PhD, of the department of health policy and management at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “For example, Medicare pays more for services delivered in hospital outpatient departments than ambulatory surgery centers (ASCs). This has led to recommendations and proposed legislation to equalize payments for some services.”
They continued: “While Medicare-related facility fee differences are well-known and Medicare and commercial plans might be concordant, less conclusive evidence exists about variations in the commercial market.”
To investigate site-related facility fee differences in the commercial market, Wang and colleagues performed a cross-sectional study using Transparency in Coverage data for three common colonoscopy procedures (procedural codes 45378, 45380 and 45385). The nationwide sample included 13,287 in-network, fee-for-service facility fees from 3,582 hospitals and 17,052 fees from 3,899 ASCs, which were disclosed by Anthem (22.9%), Cigna (25.9%), Healthcare Service Corp. (11.9%) and UnitedHealthcare (39.3%).
Results showed nationwide mean facility fees were “substantially higher” for hospitals than ASCs for codes 45378 ($1,530; 95% CI, 1,485-1,576 vs. $989; 95% CI, 970-1,008), 45380 ($1,760; 95% CI, 1,706-1,813 vs. $1,034; 95% CI, 1,015-1,054) and 45385 ($1,761; 95% CI, 1,709-1,814 vs. $1,030; 95% CI, 1,011-1,049).
Estimated hospital facility fees were 154% (95% CI, 149-159), 156% (95% CI, 151-161) and 161% (95% CI, 155-166), respectively, of those in ASCs after controlling for insurer, negotiated type and county fixed effects.
“Facility fees at hospitals were approximately 55% higher than those at ASCs in the same county and with the same insurer,” Wang and colleagues wrote. “Due to data limitations, we did not adjust for variation on system affiliation, case mix, utilization or quality of care across hospitals or ASCs. Nevertheless, the results suggest that a site-neutral payment policy for a largely homogeneous and shoppable service may generate savings for commercial plan sponsors and beneficiaries.”
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