Here are five things to know about ASC-based colonoscopies that leaders should know:
1. The majority of gastroenterology procedures performed in 2023 were charged to commercial payers, according to a report by Healthcare Appraisers. Forty-five percent of claims went to commercial payers, followed by Medicare which accounted for 38%.
2. Getting a colonoscopy at an ASC is less expensive than getting the same procedure at a hospital outpatient department, according to data from Medicare.gov. A flexible colonoscopy with a biopsy costs an average of $151 at an ASC, compared to $255 at HOPDs.
3. Undergoing a colonoscopy in the U.S. will cost patients an average of $1,608, according to data from insurance company Sidecar Health. The majority of the procedure's cost (59%) goes toward facility fees and 23% goes to the gastroenterologist, the data said.
4. Colonoscopies cost an average of 55% more at hospitals compared to ASCs, according to a study from Johns Hopkins Bloomberg School of Public Health in Baltimore. The study found hospitals billed an average of $1,530 in facility fees for colonoscopies, $1,760 for colonoscopies with a biopsy, and $1,761 for colonoscopies with removal of polyps, compared to $989, $1,034, and $1,030 in facility fees, respectively, at ASCs.
5. From 2017 to 2023, the average cost of a colonoscopy performed at an ASC increased from $859 to $925 — a jump of 7.2%, according to data from Blue Cross Blue Shield affiliate Blue Health Intelligence. At HOPDs, costs increased from $1,045 to $1,224, or 15%.