Rising Surgical Costs and How to Contain Them

The cost of surgical procedures in the United States continues to soar and seemingly sporadically rise. Stanford Health Care reported that 48 million surgical inpatient procedures were performed in the United States in 2009 [6], and that number continues to steadily increase seven years later. When surgical care becomes necessary, many consumers are left wondering what the true cost for them will be and how they will pay.

Various explanations can be offered in the case of high surgical costs, including high hospital overhead costs or a hospital’s increased market share that allows them to demand higher prices [1].

Another factor in the rising and varying costs related to medical care in the United States could be location-based. Surgical costs can vary greatly depending on where a patient received treatment. it’s been reported that knee replacements are quickly becoming one of the most common surgical procedures in the United States. The Centers for Disease Control and Prevention (CDC) reports that in 2010, total knee replacement was the most frequently performed surgery for adults aged 45 and older [2]. According to an analysis of claims data from 64 markets, the cost of a total knee replacement averaged around $31,000. This same analysis reported that a knee replacement might cost $69,654 in New York City, but the same procedure could cost a fraction of that at $11,317 if performed in Montgomery, Alabama [3].

Consumers in the United States are assuredly concerned with the cost of healthcare. TransUnion Healthcare recently released information that asserted 76% of Americans are concerned about healthcare costs and the financial strain that may be associated with them [4].

In an effort to cut costs, more and more consumers are looking for surgical options outside of high-priced hospital systems. According to the Ambulatory Surgery Center Association (ASCA), approximately 40 years ago it’s believed that virtually all surgery was performed in a hospital [5]. ASCA also reports that these out-patient ambulatory surgery centers often have transparent pricing practices and make this information available to patients prior to their procedures. Transparency in pricing is an attractive component as this is something many consumers yearn for as they attempt to contain skyrocketing healthcare costs.

BridgeHealth provides a unique solution for Plan Providers and Plan Members who are in need of a surgical procedure. By providing pre-negotiated, bundled case rates for a wide scope of surgical procedures, BridgeHealth is able to help contain costs for Plan Members and Plan Sponsors. In addition to lower surgical costs equating to little to no out-of-pocket expense, Plan Members will also benefit from high-quality care. BridgeHealth only partners with providers in the top 25% of hospitals in the country [7].

1) http://www.pbs.org/newshour/rundown/seven-factors-driving-your-health-care-costs/ – Seven Factors Driving Up Your Health Care Costs (PBS News and Kaiser Health News)
2) http://www.cdc.gov/nchs/data/databriefs/db210.htm – Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010 (Centers for Disease Control and Prevention)
3) http://www.usatoday.com/story/news/2015/01/21/blue-cross-blue-shield-knee-hip-surgery-rates-vary-widely/21999929/ – Surgery Costs Vary Wildly – Even in Same Area (USA Today)
4) http://newsroom.transunion.com/transunion-three-in-four-consumers-concerned-about-rising-health-insurance-rates-for-2017/ – TransUnion: Three in Four Consumers Concerned about Rising Health Insurance Rates for 2017 (May 04, 2016)
5) http://www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositivetrendinhealthcare – ASCs: A Positive Trend in Health Care (Ambulatory Surgery Center Association)
6) https://stanfordhealthcare.org/medical-clinics/surgery-clinic/patient-resources/surgery-statistics.html Surgery Statistics, Stanford Health Care
7) http://www.carechex.com/ScoringRatingMethods.aspx – Hospital Quality Scoring and Rating Methods, Comparion Carechex