According to report released by Physicians Advocacy Institute and Avalere, colonoscopies cost Medicare 164% more at a hospital outpatient department (HOPD) compared to independent physicians’ offices and ambulatory surgery centers (ASCs).
As hospital costs increase, many patients are choosing physicians’ offices and ASCs for outpatient procedures. ASCs are freestanding medical facilities that offer preventative services and surgical care.
Proven to be convenient, efficient and cost-effective, ASCs offer an attractive alternative to a traditional hospital setting for outpatient procedures. Many patients find they can receive the same high-quality care in a comfortable environment with shorter wait and recovery time.
Between 2012 and 2015, the study analyzed factors including physician employment trends and colonoscopy cost increases. Here are a few reasons why colonoscopies and other outpatient procedures were more expensive in HOPD settings:
When comparing costs of gastroenterology, orthopedic and cardiac services, HOPDs cost Medicare $2.7 billion more than physicians’ offices or ASCs. Patients with private insurance paid $411 million more for services at HOPDs compared to physicians’ offices or ASCs.
Medicare costs increased by 27 percent when patients chose physicians employed by hospitals to perform outpatient procedures. Patients with private insurance paid 21 percent more when having outpatient procedures performed by a hospital-employed physician.
The Medicare reimbursement rate for a colonoscopy screening in HOPDs is $1090, whereas the rate for ASCs and physicians’ offices is over 50 percent less, at $413. Of the $1090 total cost for HOPD colonoscopies, $880 is designated as the facility fee, according to Medscape.
Robert Seligson, president of Physicians Advocacy Institute, points out that healthcare mergers are driving up costs even more. "Hospital consolidation pushes healthcare costs upward," he explained. "The impact of hospitals owning outpatient practices places a greater financial burden on Medicare beneficiaries and on taxpayers” (Source: Beckers ASC)
As a Medicare patient or beneficiary of private insurance, you can make informed decisions about your healthcare. Just as you would shop around for an appliance or vehicle to find the most affordable price, do a little cost comparison before your next colonoscopy.
Take time to call your insurance company, and then contact physicians and facililities in your area to compare costs for your next screening. You may find that a physicians’ office or ASC offers the same quality care at a lower price.
Annual well visits to your primary care physician are important for establishing your colon cancer screening age. The American Cancer Society now recommends that people at average risk for colon cancer begin screening at age 45 instead of age 50.
Your screening age may be even lower if you have a family or personal history of polyps, colon cancer, inflammatory bowel disease or hereditary colon cancer syndrome, so have your doctor review your medical history at your next appointment. It’s not enough to get screened once; it’s essential to get screened at appropriate intervals.