Site of Care

Site of care means where a medical service is performed: a hospital, a hospital-owned outpatient department, a freestanding surgery center, a doctor's office, an independent imaging or infusion center, or your own home. The service is the same. The price is not, and the difference is usually the largest lever in healthcare spending that does not involve changing what care a patient gets.

The gaps are consistent enough to plan around. A colonoscopy at a hospital outpatient department in a Texas city commonly totals $2,500 to $4,000 with insurance; at a freestanding endoscopy center it is $900 to $1,500; at a surgery center with a published bundled cash price it can be under $1,300 with the doctor and anesthesia included. An infusion of a biologic drug at a hospital can cost two to four times what it costs at an independent infusion center or at home with a visiting nurse. An MRI at a hospital runs $1,200 to $2,500 against $350 to $600 at an imaging center. Plans and employers use "site-of-care programs" to guide members toward the lower-cost setting, sometimes by waiving cost-sharing there, sometimes by requiring a review before approving the hospital setting for a service that could be done elsewhere. Quality at the freestanding sites is, for the procedures they are equipped to do, as good or better.

The takeaway: for any scheduled scan, infusion or outpatient procedure, ask, "Can this be done somewhere other than the hospital?" The answer is usually yes, and the second site is usually the one you should choose.