By Bill Prentice
In the past year, Congress has been holding hearings and discussing various proposals purported to decrease the cost of health care; guarantee safe, high-quality care for patients and ensure patient access to care. States and other stakeholders have also been asking questions about current practices and considering alternatives to achieve those same goals.
As we consider what all that means for surgery centers and other health care providers, one overarching theme emerges: the devil is in the details. On the surface, many of these proposals sound like simple fixes to complex problems. In fact, many exacerbate the very problems they are intended to address, and others create new, seemingly unanticipated, problems.
Price Transparency
Price transparency has been the hottest topic on Capitol Hill this past year impacting ASCs and provides a good example of how well-intended efforts can go sideways. It is easy to agree that patients should be able to determine the cost of an elective surgical procedure or preventive screening before deciding whether and where to obtain that care. The difficulty is determining the simplest way to help them obtain all the information they need to make an informed choice.
Since being the lower cost site of service has been a defining element of the ASC model, surgery centers have always worked with their patients to help them understand the cost of their procedure. The No Surprises Act enacted in 2020 builds on this to prevent surprise medical bills by requiring all health care providers to give, upon request, a good faith estimate to patients for the care they are considering. However, regulations to fully implement these requirements have still not been finalized.
Even though the No Surprises law is still a work in progress, members of Congress now want to require providers to post prices for their services on their websites or face very substantial financial penalties. Leaving aside the practicality of patients going to various websites to price shop, it’s frustrating to see new requirements being proposed when the old ones haven’t yet been implemented or evaluated. Hopefully, cooler heads will prevail, and Congress will let the No Surprises law be fully executed before making providers waste time and money on additional solutions.
Site Neutrality
Site neutral payments are another topic that has gotten a lot of attention on Capitol Hill recently. This is another area where good intentions don’t automatically translate into good policy. At first glance, it seems sensible that health care procedures should cost the same no matter where provided. Unfortunately, that theory does not work well in practice and would create significant barriers to access to care. Both hospitals and surgery centers allocate significant resources to compliance with the regulatory requirements that apply in their facilities. Physicians’ offices, on the other hand, do not need to meet those same criteria and, therefore, can provide certain procedures at a lower cost but with trade-offs on safety that limit the types of patients that should receive care there.
Determining when the more highly regulated environment is the right setting for a patient is a clinical decision that must be made by the patient and their physician. Any site neutral policy that attempts to use an arbitrary mathematical formula – such as where patient volume is predominant or a plurality – to determine which site of service’s fee schedule should apply for all settings could cause the more highly regulated providers to discontinue offering those procedures and force patients into a less appropriate setting.
Quality Reporting
Quality measurement and reporting is another area where, despite many well-intended efforts, the goal of providing a single comprehensive set of meaningful data that improves the patient experience remains elusive. The ASC community has long supported quality reporting and continues to develop meaningful measures for surgery centers and their patients.
As measures continue to be added to the program, however, the specific contents and requirements associated with each measure need to be considered carefully to balance their value against the burden of reporting. Administratively burdensome measures can quickly drive up the overall cost of care. Reporting demands can also effect efficiency, one of the attributes of surgery centers physicians and patients say they value most.
As an example, the Centers for Medicare & Medicaid Services (CMS) currently requires ASCs to report data monthly on the COVID vaccination status of their health care workers. Implementation has been confusing, with definitions constantly changing midstream. The COVID-19 Public Health Emergency ended on May 11, 2023. Facilities have never been required to collect the vaccination status of their patients and guests, and many health care facilities no longer require their patients and guests to wear masks. And yet, surgery centers and other health care facilities must continue to report on HCP vaccination status monthly to avoid penalties. It is difficult to claim it is a matter of epidemiology when we do not know the vaccination status for a sizable number of the individuals coming through the facility daily, including the patients undergoing surgery. ASCA continues to ask for this measure’s removal, or at least a reduction to reporting annually instead of monthly.
How You Can Help
Anyone who works directly with patients in a surgery center would have a difficult time also tracking and responding to these critical policies as they arise. ASCA represents your interests in all these efforts and many more. If you work in an ASC, please make sure your facility’s membership is current in 2024 and contact Maia Kunkel at mkunkel@ascassociation.org if you would like to explore some ways to get more involved with ASCA and its advocacy for surgery centers.
Before I sign off, I have one reminder for the ASC community. In 2025 Medicare-certified ASCs need to conduct the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey or face future cuts in their Medicare payment rates. Surgery centers must select an approved vendor to administer the survey to their patients.
Finding the right vendor and setting up the survey takes time, and with thousands of ASCs preparing to begin working with a limited number of approved survey providers simultaneously, ASCA is encouraging all ASCs to start now. To help, ASCA has posted a collection of OAS CAHPS resources on our website at www.ascassociation.org/oas-cahps We invite all ASCs to use the information available there.
