The Maryland Health Services Cost Review Commission (HSCRC) commissioned Milliman to analyze outpatient facility fees in the state. This report summarizes the magnitude of outpatient facility fees currently being charged, focusing on hospitals, payers, and consumers.

This report analyzes outpatient cost sharing levels using two different service groupings: One using HSCRC rate center to identify outpatient clinic visits, and one using service codes identified by the Medicare Payment Advisory Commission (MedPAC) as services that are typically performed in a non-facility setting (e.g., in a physician’s office).

Key findings

• Cost-sharing percentage for outpatient clinic visit services varied from an average of 5% in the commercial large group fully insured line of business (LOB) to 23% in Medicare fee-for-service (FFS) using HSCRC rate centers. The MedPAC services show comparable but slightly higher cost sharing for most LOBs.
• Outpatient clinic visit services identified using HSCRC rate center codes accounted for 1.7% of total medical expenditure and a similar proportion of patient cost sharing. The MedPAC approach identified 5.3% of total medical expenditure, about three times the volume HSCRC rate center clinical visits.
• Using HSCRC rate centers, the percentage of outpatient clinic visit claim lines with cost sharing varied from 30% in the commercial large group fully insured LOB to 99% in Medicare FFS.

This report was commissioned by the Maryland Health Services Cost Review Commission.