From cost differentials to regulatory constraints and payment inequities, here are 10 key notes capturing the state of HOPDs vs. ASCs in 2025.
1. A Blue Health Intelligence analysis revealed procedures performed in HOPDs can cost up to 58% more than in ASCs or physician offices. For example, colonoscopies cost 32% more in hospital settings compared to ASCs.
2. From 2001 to 2023, Medicare payments to hospitals increased by 70%, while physician payments grew by only 9%, according to the American Medical Association. Adjusting for inflation, Medicare physician pay actually declined by 26%.
3. The national average cost of a cataract excision with lens removal (without ECP) at an ASC is $1,711, while the same procedure in an HOPD costs $2,748, based on Medicare’s price lookup data.
4. As of May 2023, private health insurance pays 55% more in facility fees for colonoscopies at hospitals than at ASCs, according to a Johns Hopkins Bloomberg School of Public Health study published in JAMA Health Forum.
5. Colonoscopies cost more in hospital outpatient departments than ASCs in all 50 states, according to data from insurance company Sidecar Health’s cost calculator. Here’s a breakdown of the average cash price for HOPDs and ASCs for colonoscopies per state.
6. As ASCs continue to grow in popularity, they face increasing competition from HOPDs
“Independent ASCs are exactly that — independent. They have fewer restrictions, and they can almost pick and choose which surgeons and anesthesia providers they work with,” Alejandro Badia, MD, founder and CMO at Miami-based Badia Hand to Shoulder Center, told Becker’s. “In a hospital outpatient department, the surgery center that’s affiliated with a hospital — they’re a little more encumbered in terms of who they can have there.”
7. The payment disparity between ASCs and HOPDs remains a contentious issue. Medicare ASC payments have seen only modest increases compared to more substantial hospital reimbursements.
“Payers may offer higher headline rates, but those gains can be offset by arbitrary reimbursement policies and administrative processes, such as increased denials, complex billing requirements and extended payment cycles,” Sean Hayes, president of the American Pain Consortium, told Becker’s.
8. The widening gap between ASC and HOPD reimbursement rates is a major financial stressor, said Kathleen Hickman, BSN, RN, administrator and clinical director of Dutchess Ambulatory Surgical Center in Poughkeepsie, N.Y.
“Costs continue to soar for supplies, pharmaceuticals, etc., with only incremental increases (or none) in reimbursements for ASCs,” she said. “Negotiating payer contracts as an independent ASCs presents significant challenges in terms of substantiating the need for higher reimbursement simply to stay ahead of operational costs.”
9. A nationwide study found ASCs treated 15% more patients from socially vulnerable areas for outpatient cardiac interventions (PCI) than HOPDs from 2020 to 2022.
10. The macro outlook for ASCs remains strong. Sg2’s 2024 Impact of Change Forecast projects a 21% increase in ASC volume over the next decade, compared to a 17% rise for outpatient volumes overall.
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