Average prices higher for outpatient healthcare, study finds

Commercially insured patients face higher prices for a set of healthcare services performed in outpatient settings compared to those at physician offices, according to a Health Care Cost Institute study.

For the study, researchers examined utilization and average price paid from 2009 to 2017 for certain services that are commonly performed in freestanding physician offices and in the hospital outpatient setting. They studied more than 44 million commercially insured patients and 46 ambulatory payment classifications — which are services considered by CMS to have similar intensity and resource utilization.

Researchers found that the amount of these services performed in the outpatient setting rose between 2009 and 2017. They also found that the average price for the services was always higher in an outpatient setting than an office one.

For example, the institute's report showed:

  • The share of the studied services performed in an outpatient setting compared to an office setting increased from 11.1 percent to 12.9 percent between 2009 and 2017.
  • The share of level 3 diagnostic and screening ultrasound visits performed in the outpatient setting compared to the office setting increased from 20.9 percent to 25.2 percent during the study period.
  • The share of level 5 drug administration visits performed in the outpatient setting compared to the office setting increased from 23.4 percent in 2009 to 45.9 percent in 2017.
  • The average price for a level 3 diagnostic and screening ultrasound visit increased 14 percent in outpatient settings between 2009 and 2017, from $568 to $650, compared to 4 percent in office settings, from $233 to $241.
  • The average price for a level 4 endoscopy upper airway visit climbed from $1,552 in 2009 to $2,679 in 2017 (73 percent) in outpatient settings, compared to 14 percent in office settings, from $463 to $527.

Access the full report here.


More articles on healthcare finance: 

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