How much money could the U.S. healthcare system save by shifting care, whenever possible, to alternative sites such as ambulatory surgery centers (ASCs), post-acute facilities, imaging centers, and home-based care?

A new study in JAMA Open Network analyzed claims data from 2019 and surveyed 1,069 clinicians in an effort to answer that question.

Clinicians believe that 10.3% of commercial and 10.9% of Medicare volume currently taking place in hospital-based settings could be safely shifted to alternative sites without compromising clinical outcomes.

The authors, Fleisher and Burke, estimate that such transitions could reduce healthcare spending by 3.2% to 4.1% annually, amounting to a savings of $110 billion to $150 billion. Over a 7- to 10-year period, with advancements in technology, even more care could be shifted, leading to potential savings of $208.1 billion (5.8%) to $303.2 billion (8.5%) annually.

They highlight the importance of removing financial disincentives that currently hinder these shifts.

Historically, healthcare was predominantly home-based until advances in medical science and the establishment of insurance systems, such as Medicare, made hospital care more accessible.

The study was published alongside invited commentary that examined the findings. In their analysis, Dr. Lee A. Fleisher and Sheila P. Burke, stressed the need to consider patient preferences and clinical judgment when determining the safest and most appropriate site for care. While outpatient care can be less costly, it may introduce risks, such as higher rates of hospital readmission after procedures. The challenge lies in balancing cost savings with maintaining quality care and ensuring that financial incentives align with patient safety.

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