AS I SEE IT
are clearly a key component of this equation. ASCs have saved billions of dollars in spending for the Medicare program and employer-based health plans, and new cost-saving programs will likely drive more patients toward ASCs, equating to more savings for the health care system. One of the strongest downward pres-
sures on employer-based health insur- ance costs is the Consumer Directed Health Plan (CDHP). A CDHP gives patients financial rewards and penal- ties based on the decisions they make as health care consumers. Common plans like the Health Savings Account (HSA), give the employee tax benefits and an opportunity to bank unspent money into a health care spending account that they own and take with them year-over-year, employer-to-employer. The deductibles are typically high in order to give the consumer “skin in the game.” The use of CDHPs by employers has skyrocketed over the last two years. About half of all large employers now offer a CDHP and about one-fourth of all covered employ- ees are enrolled in one of these plans, according to Mercer’s national survey of employer-sponsored health plans in 2014. CDHPs give the patient a giant incentive to consider the cost of services when selecting a health care provider. An ASC typically costs the patient less than the hospital outpatient depart- ment (HOPD). Just using Medicare as an example, it can cost a patient nearly double the out-of-pocket cost to have a procedure at an HOPD rather than an ASC. And that’s the exact same proce- dure, exact same doctor using the exact same equipment. So it is expected that more patients will choose ASCs as CDHPs continue to gain in popularity. As consumers become more cost- conscious, they want more price data in order to make intelligent choices. This has ignited a firestorm of inter- est in price transparency, and ASCs are uniquely poised to win big. Not only are ASC prices typically much less
are often based on time and materials and, therefore, difficult to sum up into an exact number. Transparency will eventually demand outcomes measures to be readily avail- able and comparable between sites of service. ASCs will likely show results as good or better than the alternatives, mak- ing price differentiation more important and placing ASCs in a superior strate- gic position.
While health care is a dynamic indus-
than HOPD prices, ASCs also benefit from price transparency because pricing information is usually much simpler to understand and easier to predict from an ASC than a hospital. In the world of Internet cost comparisons, consumers expect instantaneous pric- ing information. ASCs typically charge a flat fee based on the procedure, which is easier for a consumer to under- stand than the hospital’s charges that
try and no one can accurately predict its future, it is clear that the current environ- ment favors the ASC delivery model. The number of surgeries performed at ASCs will grow extensively, and the result will be improved access and better quality at a lower per capita cost for surgical care than we experience today.
Terry Bohlke is the president of ASCA’s Board of Directors and vice president of operations at National Surgical Healthcare in Chicago, Illinois. Write him at
tbohlke@nshinc.com.
ASC FOCUS JANUARY 2016
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