BCBS study: Uptick in outpatient care cuts costs for payers, patients

A new report from Blue Cross Blue Shield (BCBS) reveals how much consumers and payers save when medical procedures shift from an inpatient to an outpatient setting.

Overall, outpatient services outcomes were similar to or sometimes better than the inpatient equivalents, and some procedures had less recovery time and fewer medical complications when performed in an outpatient setting, the study found. For example, when members decided to have an angioplasty performed in an outpatient facility, they saved an average of $1,062 per procedure out-of-pocket, as compared to an inpatient facility. For hysterectomies, members in the study saved an average of $483 in out-of-pocket costs in 2014 by having the procedure done in an outpatient setting.

The study also found that over time, annual procedure cost trends were higher for inpatient procedures. Angioplasties experienced the greatest difference, with the inpatient cost trend at 6.1 percent and outpatient at 1.4 percent across the five-year time period.

While outpatient care use did increase from 2010 to 2014, overall utilization did not increase, since inpatient procedures decreased. Pressure from insurers and providers to minimize hospital stays is part of what's driving an increase in outpatient procedure use, the report adds.

Performing procedures in the outpatient setting will continue to provide valuable cost savings, the BCBS report concludes, adding, "these savings will be especially important for members who are bearing an increasing share of the cost of their care due to rising deductibles and other cost-sharing methods."

The report does not include Medicare or Medicaid beneficiaries. Medicare enrollees at critical access hospitals often pay far more out-of-pocket for outpatient procedures than patients obtaining the same care at larger institutions, FierceHealthFinance reported.

Nevertheless, some work-based health plans are starting to exclude outpatient surgeries in order to cut costs, drawing concern from the American Hospital Association.

To learn more:
- read the report (.pdf)

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