Methodology Used to Identify Top Procedures Performed at Hospitals and Free-Standing Clinics

Using the 2016 Medicare hospital Outpatient Prospective Payment System (OPPS) data that provided hospital volumes and charges by HCPCS codes, a recent research project on hospital versus free-standing facility pricing by Cleverley & Associates assembled a list of procedures performed in hospitals and then grouped them by categories similar to the groups of free-standing entities (i.e., lab tests, imaging, therapy, surgery). The data was reviewed using both total charges and total volumes. Total charges by HCPCS code were used as the best indicator of areas of concern for hospitals, although the top charge and top volume procedures frequently overlapped.

Using data from the 2015 Medicare Physician/Supplier Procedure Summary file, a list of procedures performed in free-standing laboratories, imaging centers, therapy centers, and ambulatory surgical centers was assembled. Next, each free-standing group’s procedures by CPT/HCPCS code from highest volume nationally to lowest was ranked. Once the list of procedures for both hospitals and free-standing centers was created, the top procedures by total charge for hospitals was compared to the top volume procedures performed in free-standing centers and looked at for those that were high on both lists.

See related article: Competing with Freestanding Outpatient Centers—Where to Focus on Pricing