Blue Cross Blue Shield, The Health of America Report is a collaboration between Blue Cross Blue Shield Association 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.
This report analyzed the claims data of approximately 43 million BCBS commercially insured members (excludes Medicare and Medicaid) under the age of 65 from 2010 to 2014. Data was pulled by procedure using a combination of coding processes to capture inpatient and outpatient procedures, including Diagnosis- Related Groups (DRGs), International Classification of Diseases (ICD) procedure codes and Current Procedural Terminology (CPT) codes. Cost and utilization were measured at the stay level for inpatient (total facility and all professional charges during an admission) and visit level for outpatient (total facility and professional charges for date of service). The data was not adjusted for patient risk.
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. Spine surgery and angioplasty have been shown to be safe and are associated with similar or better outcomes in the outpatient setting.3,4 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.5
This report highlights the general trend 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 report examines four shoppable procedures during the study period, two of which showed a strong shift to outpatient care (hysterectomy and lumbar/spine surgery6) and two of which remained steady but at very different levels of outpatient care (angioplasty and gallbladder removal) during the study period.7
These four procedures cost all BCBS Plans, their members and employers nationwide an estimated $11 billion in 2014.