Patients Weigh In, Support More Quality and Price Transparency M

embers of the ASC community who have been advocating for improved quality and price transparency in the US health care system for many years will find

encouraging news in two recent studies. Both reveal that faced with high-deductible health insurance plans and a need to shoulder a greater percentage of the costs of their health care, Americans have begun looking for and comparing prices before getting care. Public Agenda, a nonprofit, nonpartisan consensus-building organization, con- ducted the most recent of the two studies last summer with support from the Robert Wood Johnson Foundation. The researchers surveyed 2,010 adults and, based on their findings, concluded that 56 percent of Americans have actively looked for health care prices before getting care. They also found that about one in five Americans, or 21 percent, have compared prices across multiple providers and that those who have com- pared prices say doing so has affected their choices and saved them money. Perhaps more importantly for ASCs, the researchers also found that 71 percent

of Americans do not think higher prices indicate better quality care and 63 percent do not think lower prices are typically a sign of lower quality care. Also of note, 57 percent of insured and 47 percent of uninsured Americans are not aware that providers might charge different prices for the same services. The second study, conducted on California Public Employees Retirement System (CalPERS) patients between January 2009 and December 2013, shows the same trend toward consumer-driven health care choices. Specifically, researchers looked at a reference-based benefit (RBB) policy initiated by CalPERS for cataract surgery. Under this policy, patients who choose an ASC for their procedure do not have to pay anything but those who choose a hospital outpatient department (HOPD) have to pay the difference between the actual price charged by the provider and the CalPERS contribution. After controlling for a number of variables, the researchers’ key findings include: ■

The RBB policy was associated with an 8.6 percent increase in ASC use in comparison to a control group. By 2013, 91.4 percent of CalPERS members were using an ASC compared to 79.6 percent of the control group.

In the year following the implementation of RBB, the average price paid by CalPERS for cataract surgery declined by 10.2 percent as a result of the shift by its members to lower-priced ASCs.

In the first two years after implementation, RBB for cataract surgery saved CalPERS $1.3 million. As patients look for more price information, ASCs and ASCA have many reasons

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to want to remain at the forefront of the movement toward improved quality and price transparency. While insurance companies, large management companies and vendors in the commercial market develop tools to research out-of-pocket prices for consumers and help them find better-value care, individual ASCs have to do their part to give their patients the best pricing information. To that end, the cover story on page 10 of this issue of ASC Focus discusses different models of price transparency that work successfully in ASCs.

ASCA will continue to bring the latest trends in quality and price transparency to our members and keep you informed about effective strategies for coping with all of the related changes that affect the ASC setting. As always, please let us know about all of the related ways that we can help support you.

Bill Prentice Chief Executive Officer

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