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

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.
• 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 services that can be performed in a non-hospital setting based on the Medicare Patient Advisory Commission’s definition account for 5.3% of total medical expenditure, about three times the HSCRC rate center clinical visits.
• 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.