Fresh evidence has just emerged, reminding us of one of the existing, but often neglected, opportunities we have to reduce our health care expenditures. A new study, by Healthcare Bluebook, a national provider of quality and cost data on health care services, shows that both patients and employers could save billions by shifting commonly performed surgeries from a hospital’s outpatient setting to an ambulatory surgery center (ASC).
The bottom line, as described in Modern Healthcare:
Commercial payers save $38 billion annually when patients get care in ASCs, Healthcare Bluebook found. Patients could save another $41 billion if they had their surgeries performed in ASCs than in hospital outpatient facilities and the savings required no sacrifice in quality.
The first ASC was created in the 1970s. Today, there are more than 5,000 in the United States, most of them physician-owned. (Find one near you here.) ASCs specialize in elective surgeries and procedures; some of the most common are cataract surgery, colonoscopy, GI endoscopy, and joint replacement. Pain management is another ASC specialty. The table below, from 2012, shows the staggering difference in both patient and Medicare cost for three treatments, when performed at an ASC instead of a hospital’s outpatient facility.
Cost Comparison, ASC v OutpatientThis should be surprising to no one, since hospitals are paid more for everything they do, including services at facilities they own that are remote from the main campus and that have none of the overhead costs of running a 24/7, full-service hospital. Also to no one’s surprise, ASCs have become attractive buy-up opportunities for hospital systems. Once an ASC becomes a unit of the hospital, it can then bill its services at the higher rate that Medicare typically reimburses hospital-owned facilities.
Regardless, ASCs seem a wise choice for most patients in need of elective surgeries, procedures or diagnostic services. The Healthcare Bluebook study shows that out-of-pocket costs can be reduced $5 billion annually through lower deductible and coinsurance payments. Meanwhile, employers can reduce their costs by making employees aware of high-quality, lower-cost ASCs.
And, finally, here’s a message for insurers: You have the power to design plans to encourage the use of ASCs. So go do it.