The savings do not appear linked to price shopping for providers, given that consumer use of pricing tools remains limited.


Feb. 24—The extent to which payers and patients have benefited financially from the increasing use of outpatient procedures was quantified in a new analysis.

An analysis of claims data of 43 million enrollees with coverage through a member company of the Blue Cross Blue Shield Association (BCBSA) found that from 2010 to 2014, four elective procedures generally moved toward outpatient settings and provided large savings to payers and patients.

The share of hysterectomies performed on an outpatient basis increased from 36 percent to 64 percent, while outpatient lumbar/spine surgery increased from 61 percent to 82 percent and outpatient angioplasty increased from 43 percent to 50 percent. The outpatient rate of the fourth elective procedure, laparoscopic gallbladder removal, remained essentially unchanged during the review period but already had reached 80 percent.

“The remaining 15 percent to 20 percent of gallbladder surgeries that are performed inpatient likely involve patients who are not good candidates for outpatient surgery and are thus not likely to shift substantially in the future,” the authors wrote.

The shift to outpatient settings for the four common elective procedures came as the overall number of each procedure declined, the insurer organization found. The trend was generally echoed in reductions in inpatient volume for each procedure, including for gallbladder removal.

The insurers credited the shift from from inpatient to outpatient settings with providing steep savings on the procedures, on which the insurers, employers, and patients spent $11 billion in 2014.

“Performing procedures in the outpatient setting will continue to provide valuable cost savings,” Maureen Sullivan, chief strategy officer and senior vice president of strategic services for BCBSA, said in a release. “These savings will be especially important for members when they need surgical care and will help them save money.”

The shift saved an average of $320 in out-of-pocket costs for each patient undergoing lumbar/spine surgery in an outpatient setting instead of in an inpatient setting, $483 per hysterectomy, $924 per gallbladder removal, and $1,062 for per angioplasty.

Total savings from the shift in setting were much greater: $4,505 per hysterectomy, $8,475 per lumbar/spine surgery, $11,262 per gallbladder removal, and $17,530 per angioplasty.

“For appropriate patients, outpatient surgery has been shown to be safe and effective, achieving similar or better outcomes as inpatient procedures while allowing patients to spend less time in a medical facility, recover faster and incur less pain,” Sullivan said.

This study is the fifth by Blue Cross Blue Shield’s The Health of America Report series, a collaboration between BCBSA and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and provide insight into healthcare affordability and access to care.

Shopping Unmeasured

The report referred to the four procedures as “shoppable,” but no evidence was presented to indicate patients compared prices among providers performing the procedures.

 A recent survey by America’s Health Insurance Plans (AHIP) of 31 commercial plans with a total of 141 million enrollees found 97 percent of the plans offered price tools on elective surgeries. However the utilization metrics indicated to the authors that little more than the 2 percent of enrollees that was found in previous research used the price comparison tools.

Leah Binder, president and CEO of the Leapfrog Group, said in an interview that her group has found consumer use of insurers’ price comparison tools has lagged because of problems with accuracy.

“That’s a big deal because if the price is listed as $500 and then you get there, get your bill, and it is $2,000, that matters to you,” Binder said.

Another obstacle to comparing prices among elective procedures is the challenge of finding the information. A possible solution, Binder said, is in the increasing prevalence of third-party vendors that provide price and quality information on procedures to insurers and the general public.

Binder criticized insurer price transparency tools for frequently focusing on high-cost inpatient procedures that would exceed consumers’ deductibles no matter how much they shopped around.

“If consumers are going on a website that’s supposedly providing price transparency and not giving consumers the information they want, then they are not going to use it,” Binder said.

Impact on Hospitals

Inpatient surgical volumes were mostly stable in 2015 after several years of erosion, according to a Fitch Ratings analysis of the not-for-profit hospital sector. The analysis, released in December, also found outpatient surgical volumes increased from 2014.

“Fitch believes the trend reflects not only increased coverage under Medicaid, but also absorption of volume impacts from readmission reductions, Medicare’s ‘two midnight rule’ and the growth in high-deductible health plans over the past few years,” the report stated.

Fitch expected overall stability in clinical volumes in 2016, with a continued shift toward outpatient procedures.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, February 24, 2016