Are Freestanding Surgery Centers better for patients or doctors?
WHAT ARE ASCs?
Are all cost reduction options in healthcare beneficial to you? During the past 20 years, the burgeoning cost of medical care has contributed to the rise of the Freestanding Ambulatory Surgery Center (ASC). These facilities provide low-cost surgical procedures, mostly in the areas of ophthalmology, orthopedics, and/or pain management, outside of the confines of the hospital. ASCs or “surgicenters” are scattered throughout the U.S., located in urban and rural areas. These are small community facilities, where surgeons can quickly conduct services. ASCs serve as an alternative solution to using a hospital for most patients, possibly even you.
According to the Texas Ambulatory Surgery Center Society, in 2014 there were roughly 23 million surgeries performed in ASCs, which was the equivalent of 1/3 of all surgeries nationally for that year. Numerically, ASCs are quickly outpacing hospitals. There are several reasons for this. ASCs are more centrally located in the community, meaning ASCs are more abundant. Patients can more conveniently access these facilities, allowing for surgeries to be scheduled and performed faster. Surgeons operating in ASCs are often specialists in a few procedures, which are performed in high volumes. The patient cases are usually less complex, so services can be administered within a few hours. Conversely, Hospitals are more diverse, offering the full range of services with higher costs. Theoretically, the ASC model allows for patients to avoid hospital admission and receive similar care, all while keeping money in their pockets. Problem solved, right? Not quite. A closer look at the data provides a more nuanced picture of the costs and benefits of ASCs for patients.
Does the Patient Really Benefit?
While ASCs do offer a cheaper option for certain procedures, there are clear and important limitations. Approximately 91% of ASCs are owned or co-owned by doctors. This means that there is an incentive for physicians to refer as many patients as possible to their facilities. The more surgeries the physician can perform at their ASC, the higher their paychecks. This results in a conflict of interest. How do you know your physician is safely referring you to the correct facility for your service? The simple truth is there is no way to verify. If complications occur, patients are ambulanced to a hospital near the ASC for more complex care.
Recent statistics indicate that 68 million Americans receive Medicaid assistance. Arguably, it would be this portion of the population that might stand to benefit significantly from the services of ASCs. However, there are a number of ASCs that do not participate with Medicaid due to their policy of “no charity assistance.” As a result, these patients are only left with one option, which is to have services performed at the hospital.
Another vulnerable group is insured patients who cannot pay for their cost share of the procedure. Patients turn to an ASC with the expectation of saving money, only to find that they have still incurred significant medical debt. Some of this is related to confusion regarding whether or not the ASC is “in-network” or “out-of-network”. In some instances, the patient assumes the ASC and/or anesthesiologists are also “in-network” and approved by their plan and many times they are wrong. This assumption often is due to the referring physician/surgeon. Patients believe if the surgeon is participating, then the surgery will be covered. This is a highly incorrect assumption. The surgeon, ASC and anesthesiology groups are different entities, meaning all have to be participating in your network. These entities are all contracted with your insurance plan independently. If just one is “Out-of-Network”, this results in the patient paying out-of-pocket or higher costs for the surgery. In some cases, the health plan will pay 100% of the costs to the surgery center to protect the patient. In these situations, are the costs of the surgery really lower than those performed at the hospital? Is the patient really benefiting? Patients are misinformed and ill-formed by doctors and this leads to high costs for surgeries. The scary part is this happens regularly.
Perhaps hospitals are Not Such a Bad Idea after All?
Again or Remember, most ASCs do not render any charity services to patients. Meanwhile, 50% of hospitals in the US are non-profit. The benefit of non-profit or not-for-profit hospitals is the facilities are required to use additional financial overages to benefit the community. In fact up to 60% of uncompensated care is provided by hospitals, which render the majority of services to patients with financial limitations. This equates to roughly $84.9 million each year. So, while hospitals may have higher overhead charges, they are still able to provide comparatively more assistance to financially disadvantaged patients.
So, as a patient, which one should you choose? To reiterate, ASCs DO provide discounts for some distinct procedures in areas such as pain management, ophthalmology, orthopedics, and increasingly for spinal injuries as well. It is simply imperative to note the limitations of this assistance so that you can make a sound decision regarding where to have your surgery or medical issue addressed. Make sure to verify with your health insurance plan before the procedure. Once the medical bill arrives, it is generally too late.
Article by HealthcareDeciphered.com
Editing by Leanne Tyler