Lowering health care costs with site-neutral payments

When it comes to the cost of your health care, location matters. But it shouldn’t.

A new report analyzes the cost of six common outpatient procedures as delivered to 133 million Blue Cross and Blue Shield members between 2017 and 2022. Specifically, it examines the cost variance for these procedures when performed in hospital outpatient departments (HOPDs), ambulatory surgical centers (ASCs) where patients receive same-day outpatient care and doctor’s offices:

• Cataract surgery
• Colonoscopy screening
• Diagnostic colonoscopy (with biopsy or excision)
• Mammogram
• Ear tympanostomy (ear tube placements)
• Clinic visits

Across these procedures, we found that HOPDs were charging more—in some cases more than twice as much —for the exact same service. Their prices also increased faster each year compared to doctor’s offices and ASCs.

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Action is needed

This research suggests that a site-neutral payment policy could drive substantial cost savings for patients, employers and employees. Site-neutral means you pay the same amount for the same medical service no matter where that service takes place.

To tackle this issue, the Blue Cross Blue Shield Association supports commonsense, bipartisan legislation to advance site-neutral policies, including The SITE Act and The FAIR Act. This would save Americans nearly $500 billion over the next decade.

Key findings

• Mammograms cost 32% more in an HOPD than in a doctor’s office.
• Colonoscopy screenings cost 32% more in an HOPD than in an ASC and double the cost compared to when performed in a doctor’s office.
• Diagnostic colonoscopies cost 58% more in an HOPD than in an ASC and more than double the cost compared to when performed in a doctor’s office.
• Cataract surgery costs 56% more in an HOPD than in an ASC.
• Ear tympanostomies cost 52% more in an HOPD than when performed in an ASC.
• Clinical visits cost 31% more in an HOPD setting than in a doctor’s office.
• Implementing site-neutral payment policies can curb rising costs, making health care more affordable and accessible for everyone.