Blue Cross Blue Shield Association Study Shows How Consumers Save With Shift To Outpatient Care

Data show significant savings for consumers and payers

CHICAGO – A new study by the Blue Cross Blue Shield Association (BCBSA) demonstrates how much consumers and payers save when medical procedures shift from an inpatient to an outpatient setting.

The study, "How Consumers Are Saving with the Shift to Outpatient Care,” examines four common shoppable* procedures — hysterectomy, lumbar/spine surgery, angioplasty and gallbladder removal — from 2010 to 2014. These four procedures cost Blue Cross and Blue Shield (BCBS) companies, their members and employers nationwide an estimated $11 billion in 2014.

KEY FINDINGS: Patients who utilized outpatient procedures saved money in 2014:

  • $320 on average for lumbar/spine surgeries

  • $483 for hysterectomies

  • $924 for gallbladder removals

  • $1,062 for angioplasties

Total average costs for consumers, payers and employers in 2014 also went down when shifting to the outpatient setting:

  • $4,505 per hysterectomy

  • $8,475 per lumbar/spine surgery

  • $11,262 per gallbladder removal

  • $17,530 per angioplasty

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

This report** also measured the varying shifts from inpatient to outpatient settings for each of the four procedures. Hysterectomy underwent the most dramatic shift during the study period, with the proportion of outpatient procedures increasing from 36 percent to 64 percent, while the proportion of outpatient lumbar / spine surgery grew from 61 percent to 82 percent. Angioplasty’s outpatient share increased modestly from 43 percent to 50 percent.  Laparoscopic gallbladder removal remained essentially flat at 80 percent, having already shifted to mostly outpatient by 2010.

“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.

Spine surgery and angioplasty have been shown to be safe and are associated with similar or better outcomes in the outpatient setting. Additionally, outpatient hysterectomy was found to have fewer 30-day complications, lower risk of perioperative morbidity, less risk of wound complications and other medical complications compared to inpatient, even after adjusting for demographic and operative differences between the two groups***.

This study is the fifth by Blue Cross Blue Shield, The Health of America Report, 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.

For more information, visit

* This report highlights general industry shifts in site of care from 2010 to 2014 for select elective or “shoppable” procedures that could be performed in either inpatient or outpatient settings. Shoppable procedures were selected based on consumer interest in pricing and include planned procedures performed on a non-emergency basis that allow patients time to search for providers and select where and when they would like to receive surgery.

** This analysis is based on four years (2010-2014) of independent BCBS companies’ claims data, focusing on people ages 18 through 64. The dataset contains over 43 million BCBS commercially-insured members (excludes Medicare and Medicaid).

*** Liu JT, Briner RP, Friedman JA. Comparison of Inpatient vs. Outpatient Anterior Cervical Discectomy and Fusion: a Retrospective Case Series. BMC Surg. 2009 Mar 5;9:3.

Slagboom T et al. Outpatient Coronary Angioplasty:Ffeasible and Safe. Catheter Cardiovascular Interv. 2005 Apr;64(4):421-7.

Khavanin N et al. Comparison of Perioperative Outcomes in Outpatient and Inpatient Laparoscopic Hysterectomy. J Minim Invasive Gynecol. 2013 Sep-Oct;20(5):604-10.

About BHI
Health Intelligence Company is the nation’s premier health intelligence resource, delivering data-driven insights about healthcare trends and best practices, resulting in healthier lives and more affordable access to safe and effective care. HIC accesses healthcare claims data from more than 140 million individuals nationwide, collected over nine years, in a safe, HIPAA compliant and secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Health Intelligence Company, LLC operates under the trade name Blue Health Intelligence (BHI) and is an Independent Licensee of BCBSA. For more information, visit

About Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter.

The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.