MESSAGE FROM THE CEO Transparency to a T W
hile consumers can compare prices and make informed decisions before buying myriad products and services, cost and quality of health care ser-
vices are not easily available. That needs to change. To help promote transparency, the US House of Representatives passed the
Ambulatory Surgical Center (ASC) Payment Transparency Act of 2018 (H.R. 6138) in July 2018. This important legislation, if passed by the Senate and signed into law by the president, will improve access to high-quality outpatient health care.
In addition, the Centers for Medicare & Medicaid Services (CMS) recently released its online Procedure Price Lookup tool that allows patients to compare national average prices for procedures done in both ASCs and hospital outpatient departments (HOPD). While the new tool is a step in the right direction, it has a long way to go to effectively achieve its goal. Here is why. The Procedure Price Lookup tool shows one of the same prob- lems as CMS’ online databases: it uses CPT codes for procedures. However, patients don’t know CPT codes. It also makes it difficult for patients to under- stand how much they would pay out-of-pocket because the prices posted for the total cost and the patient out-of-pocket cost are averages that do not fac- tor in regional pricing variations. In addition, patients with a supplementary Medicare plan or another insurance will likely find noticeably different prices for the same procedure. The tool shows us that for certain high-cost procedures, the payment system
places limits on patient copays performed in HOPDs but not in ASCs. This could mislead patients using the tool to choose the higher-cost provider to save a few dollars on their copay, all the while driving procedures to the higher-cost setting and costing Medicare thousands of more dollars. ASCA is looking into ways to resolve this discrepancy in the ASC-HOPD payment system. In the meantime, ASCs need to do their best to provide their patients with the price of their procedure. As insurance plans require patients to pay higher deduct- ibles and higher out-of-pocket costs, price transparency continues to be an impor- tant element of quality care.
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6 ASC FOCUS APRIL 2019 |
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Quality of service is another area where ASCs need to be more transparent. Higher cost does not equal better quality care, and we need to find a way to help our patients see that. Finding common quality metrics with HOPDs, however, remains an issue. ASCs and HOPDs report quality metrics in different ways at both the state and federal levels, so these measures cannot be compared. ASCA has been working with CMS for more than a decade to develop a system for reporting quality measures that ASC patients can comprehend and compare. While we have made progress, work still needs to be done.
Bill Prentice Chief Executive Officer
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