is no clear timeline for finalization of these policies, ASCs are a provider type that could be liable for penalties in certain scenarios involving sharing of EHI.

Patient Satisfaction Surveys The Outpatient

and Ambulatory

Surgery Center Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey went national in 2016 and was a step in the right direction for monitoring patient experience. OAS CAHPS remains strictly voluntary, but many ASCs, anticipating a more competitive environment for 2020, are already survey participants. These ASCs use the surveys in marketing to gain access to CMS-approved patient experience data and to access state and national benchmarks. Surveys include questions ranging from the quality of facilities and staff, to specific communication about the procedure the patient is undergoing, as well as overall facility ratings and recommendations. Of

course, some smaller cen-

ters may bypass CAHPS and cre- ate their own surveys. According to recent data, compare/ASC-patientsurvey.html, 402 centers participated in surveys conducted this spring. Whether they go the OAS CAHPS route or create their own survey, sur- gery centers are ramping up efforts to better track patient experience and satisfaction. As surveys become more prevalent, ASCs should strive to prior- itize patient communication and con- tinue to make patients feel welcomed and respected.

High Deductible Health Plans It is not just the potential for mandatory CMS surveys that has ASCs upping the ante when it comes to patient expe- rience. The rise of high deductible health plans (HDHP) has shifted the healthcare cost burden to the insurance

policyholder. As more patients rely on HDHPs, ASCs have to adapt to this change in patient responsibility. In 2007, 85 percent of adults with

employment-based health coverage were enrolled in a traditional plan, with an average deductible of $379 (adjusted for inflation) for single coverage. Today, only 56.6 percent have a traditional plan, with 43.4 percent enrolled in an HDHP. The minimum HDHP deduct- ible stands at $1,350 today, or more than triple the 2006 figure for a tradi- tional plan, according to the Centers for Disease Control and Prevention. In addition, a study by the Los Ange-

les Times and Kaiser Family Founda- tion found that “Over the same time, insurance premiums also increased, rising at more than double the rate of inflation and outpacing wage gains.” When patients access healthcare, it is not likely they have the funds to meet even the lowest deductible before doing some major financial juggling. According to data from the Federal Reserve, 61 percent of adults could cover an unexpected $400 expense, but 39 percent would have to borrow money, sell something or simply not be able to cover it at all. Earlier, clinicians may have been worried about how they would be

paid by the uninsured, and ASCs were largely spared because most require that patients be insured or be cov- ered by Medicare or Medicaid. With HDHPs, now the patient responsibil- ity portion of any HDHP policy can also create challenges in collections. If they have not already, ASCs must increase their patient educa- tion efforts and provide clear direc- tion on how patients can work with their insurer to determine their out- of-pocket responsibility in advance. Other impacts include scheduling— many with HDHPs will schedule their surgery early in the year to meet their deductible—revenue cycle manage- ment and the added pressure to avoid common coding mishaps that add to time and cost considerations.

The Challenge of Price Transparency Not surprisingly, with the patient cost burden rising, consumers are going to need insight into healthcare costs. While resources like Healthcare Blue- book are a good place to start, consum- ers need more specific information. CMS launched the Procedure Price Lookup Tool last year to give prospective ASC and hospi- tal patients the national average that Medicare pays for certain surgeries. Previous price transparency guide- lines established from the Afford- able Care Act also were updated to require hospitals to publish the stan- dard charges in an online, machine- readable format. The information must be updated at least annually. As with politics, however, all health- care is local. ASCs should consider vol- untarily posting cash prices to enable some comparative shopping, as 11 centers in eight states did according to my analysis.

According to an April 2019 study

in Health Affairs, the centers, identi- fied through the Free Market Medical Association, make sure data is readily accessible and easily understandable, using tools like online “body maps” to


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