Avalere: Medicare payments, spending higher in hospital outpatient centers than other settings

Medicare services performed in a hospital outpatient setting usually have the highest payment rates, according to a recent study from Avalere Health, a Washington D.C.-based healthcare consulting firm.

For the study, Avalere compared Medicare payment differentials for episodes of care in hospital outpatient departments and physician office settings for three procedures: cardiovascular imaging, colonoscopy and evaluation and management services.

Below are two key findings from the Avalere study.

1. Payments for services performed in hospital outpatient departments were higher for a primary procedure.

Average payments for cardiac imaging procedures were 217 percent higher in a hospital outpatient setting than a physician's office, according to the study. Medicare payments for colonoscopies were also higher in outpatient departments.

2. Procedures performed in hospital outpatient departments were more likely to be followed by additional medical procedures compared to those performed in office-based settings during three-day and 22-day episodes of care, according to the report.

For a 22-day episode of care for a colonoscopy, payments to outpatient departments were 35 percent higher than those to physician offices. Similarly, for 22-day cardiac imaging episodes of care, hospital outpatient departments generated payments 80 percent higher than office settings.

The study's author's suggested Medicare payment differentials and Medicare spending may be amplified throughout episodes of care that begin in an outpatient department.

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