By Bill Prentice
Ambulatory surgery centers (ASCs) are a significant source of lower-cost outpatient care, yet Congress is considering new price transparency requirements that would require ASCs to disclose pricing and ownership information. The Ambulatory Surgery Center Association (ASCA) supports providing patients with clear, understandable information about their out-of-pocket costs, but much of the information that Congress is proposing to require is already available under the federal Transparency in Coverage rule. These additional reporting requirements would create administrative and financial burdens for ASCs but not give patients any useful new information.
During the 119th Congress, ASCA worked with members of Congress to explain that transparency efforts should focus on information patients can actually use when making healthcare decisions – particularly their expected out-of-pocket costs – rather than requiring facilities to publish large volumes of technical pricing data that would be unintelligible to them.
Several transparency proposals were under consideration before Congress left for its September recess, including the Patients Deserve Price Tags Act (S. 2355), the Lower Costs, More Transparency Act (H.R. 9393) and the Health Care Price Certainty for All Americans Act (H.R. 9645). Of these measures, S. 2355 would particularly burden ASCs.
What S. 2355 would require of ASCs
Beginning Jan. 1, 2028, S. 2355 would require each covered ASC to publicly report its “standard charges” every quarter, unless the facility’s charges were already reported through a hospital’s transparency requirements. The legislation also would require ASCs to disclose information about their ownership.
The term “standard charges” hides a host of disclosures that provide little useful information to patients, while creating additional administrative burdens for ASCs and weakening their position in negotiations with commercial insurers. ASCs would be required to disclose:
- Descriptions of services and applicable billing codes, including relevant modifiers
- Gross charges for individual services
- Discounted cash or self-pay prices
- Negotiated rates associated with individual insurers and health plans
- The highest and lowest negotiated amounts for services, presented on a de-identified basis
- Facility fees and other potential add-on charges, along with information explaining when those charges may apply
- Additional information that could be required by the Department of Health and Human Services
The legislation also would require disclosure of detailed ownership and investment information, including the names and business addresses of individuals or entities with ownership, control, management or significant investment interests in an ASC.
Much of the data is already available
Under the federal Transparency in Coverage rule, most non-grandfathered health plans have been required since January 2022 to publish machine-readable files containing negotiated rates for covered services furnished by in-network providers. ASCs are included within the scope of those requirements. The 2020 final rule estimated that the requirements would cover approximately 92% of people with private health insurance.
The existing rules also contain information concerning out-of-network care. Health plans must report allowed amounts – the maximum amount the plan will pay for a covered service from an out-of-network provider – as well as providers’ billed charges. Consequently, significant amounts of ASC pricing information are already accessible to consumers, employers, researchers and technology companies through insurer data.
That information also has been used to examine the cost differences between ASCs and hospitals. For example, a November 2024 analysis published in the American Journal of Managed Care used Transparency in Coverage data to compare outpatient procedure costs and found that ASC charges were, on average, less than half of hospital charges for the procedures examined.
In addition, under the No Surprises Act, ASCs must provide their patients with a good-faith estimate of expected charges. A separate ASC reporting mandate for self-pay pricing could therefore overlap with information that facilities are already required to provide.
Impact on independent ASCs
According to ASCA’s research, physician-owned and independent facilities continue to represent more than half of ASCs nationwide. These facilities are small businesses providing high-quality, lower-cost outpatient surgical services. New federal reporting requirements would require them to devote costly time and resources to maintaining pricing files, tracking payer-specific information, monitoring regulatory requirements and ensuring that publicly posted data remains accurate.
Before imposing costly and duplicative requirements on ASCs, Congress should first consider the pricing information that is already available under existing federal regulations. ASCs provide substantial cost savings for both patients and insurers: In 2024, ASCs generated an estimated $5.1 billion in savings for Medicare and are projected to save the program $84.8 billion between 2025 and 2034. Commercial insurers and their members also benefit when procedures are performed in lower-cost ASC settings.
A more targeted approach is warranted
Transparency policies should account for not just how much information is disclosed, but also for whether that information helps patients understand their costs and whether the requirements impose unnecessary burdens on facilities that are already helping reduce healthcare spending.
Rather than requiring ASCs to independently reproduce large amounts of pricing information that insurers are already required to publish, policymakers could focus on making existing data easier to use. That could include improving the accessibility and usability of information about patients’ expected out-of-pocket costs and developing tools that translate complex insurance pricing data into information consumers can understand.
The goal of transparency should be to help patients make informed decisions while preserving the ability of ASCs to compete on cost and quality.
