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By Bill Prentice

Research results released in early September demonstrate, once again, that ASCs deliver significant savings to patients, employers and insurers and could save all those entities substantially more. What sets this research apart from much of the other research we have seen on this topic in recent years is that this analysis, conducted by UnitedHealth Group, is based entirely on private claims data. In addition, the researchers took the steps needed to avoid inappropriately assigning potential cost savings to patients who could not reasonably expect to get the outpatient care they needed in an ASC due to complex health conditions or their distance from an ASC.

Two of the study’s key findings are:

  • The average price of common procedures performed in a hospital outpatient department (HOPD) in 2019 was $7,716 – 144 percent more than the average price of the same procedures performed in ASCs ($3,157).
  • Shifting procedures from HOPDs to ASCs would reduce the cost of a procedure by an average of 59% and save consumers $684 per procedure.

To produce those findings, the researchers looked at 12 months of data on outpatient procedures and surgeries performed from March 2019 through February 2020. The outpatient procedures and surgeries the analysts considered included operations performed on the digestive system, musculoskeletal system, urinary system, nervous system, integumentary system, hemic and lymphatic system, cardiovascular system, respiratory system, endocrine system, nose, mouth, pharynx, eye, ear, and female and male genital organs

Analyzing United Healthcare data and using the patterns they observed there to estimate statistics nationwide, the researchers determined that of the more than six million routine outpatient procedures performed in hospital outpatient departments:

  • only 10 percent of procedures are for complex patients, such as those with morbid obesity or those suffering from end stage renal disease, and
  • 35 percent of procedures are for patients who do not have an ASC near their homes.

Based on those observations, the researchers concluded that 56 percent of HOPD procedures are for non-complex patients and can be performed at ASCs within a short distance of the patient’s home.

They also concluded that commercially insured individuals are responsible for approximately 15 percent of the cost of outpatient procedures, which led to the finding that shifting these common procedures to ASCs would save consumers $684 on average per procedure.

The savings ASCs deliver to Medicare and its beneficiaries are already well-documented in numerous studies including a recent KNG Health Consulting analysis titled “Reducing Medicare Costs by Migrating Volume from Hospital Outpatient Departments to Ambulatory Surgery Centers.” That report also demonstrates that potential future savings are even greater than what has been seen in the past.

The savings ASCs offer are also immediately obvious to patients who use the Procedure Price Lookup Tool that Medicare makes available on its website. Unfortunately, that tool also reveals a flaw in the Medicare payment system that affects patient copays for several higher-cost procedures that are now available in both HOPDs and ASCs. More than 20 years ago, Congress agreed to cap patient copays for these procedures when they are performed in the HOPD setting and to make the hospitals whole for the entire amount patients would otherwise pay. The same policy is not in place for ASC patient copays. The result is that while ASCs provide the Medicare program with significant savings when they perform these higher-cost procedures, patients pay more, so many elect to have them in HOPDs instead. When they do, the procedures cost Medicare more. ASCA is working with Congress to have this situation corrected.

Nurse Recruitment and Retention

As the pandemic continues, the popularity and number of ASCs continue to grow, with patients and physicians turning to ASCs as a high-quality, low-cost alternative to hospitals stretched to their limits providing care to COVID-19 patients. In response, this summer, the number of CMS-certified ASCs rose to more than 6,000 for the first time in the industry’s history.

At the same time ASCs are pleased to see this recognition of their ability to treat more patients and provide expanded services without compromising on the quality of care provided, they are facing a national nursing shortage that is requiring all health care providers to go the extra mile to recruit and retain skilled staff. In fact, in September, the American Nurses Association, asked the U.S. Department of Health & Human Services to declare the current nursing staffing shortage a national crisis and outlined steps the department could take to address the issue.

The more flexible hours ASCs offer and the lack of COVID-19 patients in the ASC setting can provide an attractive alternative for some nurses who are exhausted from working long hours in the hospital providing care to COVID-19 patients. ASCA’s 2021 Salary & Benefits Survey can also help ASCs evaluate the salaries and benefits they are offering and develop competitive packages. ASCA also offers a Career Center ASC professionals can use to post openings or look for jobs.

Looking Ahead

Despite the challenges, as the U.S. continues to look for ways to reduce the cost of health care, ASCs are already part of the solution and have the capacity to do more. Health policymakers, insurers and care providers across the country need to explore more ways to give patients whose care can be provided in an ASC access to the many benefits ASCs provide.

Bill Prentice is the chief executive officer of the Ambulatory Surgery Center Association (ASCA).

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