AS I SEE IT
The Value Proposition for ASCs Providers that demonstrate higher quality, affordable access and lower cost stand to win BY TERRY BOHLKE, CASC, AND BRANDON FAZIO
Mike Williams is production manager for a small manu- facturing com-
pany in middle Tennessee. He and his wife bring home around $52,000 per year, which is the average annual income for families in the US. Mike and his family get their health coverage from an exchange plan that costs $13,000 per year, or about one-fourth of their annual income, before providing any actual health services. Earlier this year, Mike injured his knee playing football with his two sons, which earned him a visit to an orthopedic surgeon and the need for a knee arthroscopy. After receiving a quote from the hospital for $9,200 and consid- ering his $5,000 deductible and 20 per- cent coinsurance, Mike decided to live with his knee pain. Mike’s story is all too common, so
it is no wonder we frequently hear how Americans are fed up with the cost of health care, or at least the cost of health insurance and the perceived paltry cov- erage they receive for their insurance premiums. At the same time, as our economy progressively transfigures into a global market, American businesses find themselves ever more competi- tively disadvantaged against companies from other countries without similar health care cost burdens. In 2016, the US Department of Health and Human Services projects the US will spend $3.35 trillion dollars on health care, or $10,345 per person. As these expenditures spiral out of control, US employers are desper- ately looking for any way to reduce the debilitating costs of health benefits and exerting tremendous pressure on
tional outcomes and experience higher patient satisfaction than in other surgi- cal settings. Quality of care for out- patient surgical services is often mea- sured by patient safety, which includes rates of infection, medication errors, transfers to a hospital, adverse events, etc. ASCs routinely demonstrate the highest levels of patient safety and experience extremely favorable rates in all these measures.
health plans to justify the high costs. In turn, payers are demanding that health care providers demonstrate meaningful value for their services.
In our discussions with health plans, the value proposition is driving the conversation more than ever before. In this new era of value, providers that consistently demonstrate higher qual- ity, affordable access and lower cost stand to win. While many providers are struggling to find ways to meet these objectives in their particular segment of the health care industry, we find that ASCs are uniquely positioned to excel in this new environment.
ASCs Provide Quality Care with a Better Patient Experience The patient experience for surgical ser- vices includes an expectation of the highest quality of care received, achiev- ing the desired outcome and excel- lent customer service. While the data reports needed to measure outcomes are lacking, most physicians who operate in ASCs do so because they know from experience their patients have excep-
ASCs Provide Access to Affordable Surgical Services For health to improve in our modern delivery system, patients must have access to care. The ASC industry pro- vides this much needed access, per- forming roughly 41 percent of outpa- tient surgeries in the US. Without ASCs, many people who need surgery might never receive it. Not only are the out- of-pocket costs for a hospital stay pro- hibitive, many patients are frightened by the hospital experience and choose to delay or forgo surgeries for these rea- sons. While this might seem cost-bene- ficial to the system in the short term, the end result of delaying a needed surgery often leads to complications and a big- ger problem down the line. For more than a decade, commer-
cially insured patients have absorbed the brunt of higher health care costs through increased health care premi- ums and higher patient co-pays, coin- surance and deductibles that have risen much faster than the growth in wages. This trend has accelerated in recent years as high-deductible plans are becoming the new norm. According to the Kaiser Family Foundation’s latest health benefits survey, the percentage of workers in high-deductible plans
The advice and opinions expressed in this column are those of the author’s and do not represent official Ambulatory Surgery Center Association policy or opinion. ASC FOCUS JANUARY 2017 9
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