Consumers are now paying for a greater percentage of their healthcare bills. The average annual out-of-pocket costs per patient rose almost 230 percent between 2006 and 2015, according to a report from the Kaiser Family Foundation.1 In addition, more employers are offering high-deductible health plans than ever before. In fact, the number of employers offering HDHPs grew from just 23% in 2016 to 44% in 2017 in the education industry, 41%in 2016 to 51% in 2017 in retail, 48% in 2016 to 54% in 2017 in manufacturing and 55% in 2016 to 61% in 2017 in manufacturing, according to a study from Benefitfocus.2
These consumer-focused plans are resulting in the cost savings that they were designed to produce–sort of. Consider the following: A study published in the American Journal of Managed Care found that consumer-directed health plans have resulted in a $231.60 reduction in annual outpatient spending for members. Interestingly, however, the study also found that members in these high-deductible plans used about the same amount of low-value imaging, laboratory tests and procedures as their counterparts in traditional health plans.3
With value-based care now entering into the equation, this should all change. Under value-based models, healthcare providers are increasingly reimbursed based on the quality of care achieved, not just the volume of services delivered. As such, providers will realize financial rewards that are tied to specific quality outcomes and could subsequently eliminate some low-value services. While the model makes perfect sense in theory, real-life challenges abound. More specifically, healthcare providers including ambulatory surgery centers (ASCs) are struggling to assess cost and quality data in tandem – making it difficult to acknowledge whether value-based equations compute. This, in turn, is making it difficult for consumers to recognize and realize the benefits associated with this emerging care delivery model.
Ambulatory surgery centers (ASCs), however, could help value-based care move out of the ivory tower and into the real world. Fortunately, ASCs are perfectly positioned to deliver on the model’s promise. ASCs have been intentionally developed to provide cost-effective, quality care from the get-go. Indeed, ASCs are held to an extremely high standard and many are often solely focused on performing certain types of surgeries, thus the surgeons and supporting surgical team are well versed in specific procedures and their required safety protocols. This often leads to a more focused approach with fewer variables, leading to fewer complications and lower infection rates.4 Infection rates following surgeries performed at outpatient surgical centers, for example, are relatively low, according to a study published in the Journal of the American Medical Association. The study found that 3 out of every 1,000 patients who undergo surgery at ASCs are treated for surgical cite infections at 14 days post-op, a rate that increases to nearly 5 out of every 1,000 patients at 30 days post-op.5 By comparison, surgical site infections in hospitals have been reported to occur in 2%, or 20 out of every 1,000 patients.6
ASCs, however, need to not only deliver quality care at a reduced cost, they need to prove that they are doing so as well. To that end, many healthcare providers are starting to post prices for various procedures on their websites. The practice is actually mandated by a number of states.
Cost or price information really is of little value if it can’t be ingested along with quality information, though. Imagine that a patient has hernia surgery and chooses the lowest cost surgeon to perform the procedure. The patient, however, winds up in the emergency department two weeks after the surgery – and has to undergo a subsequent procedure. The cost savings is now negated, as the care experience will cost much more in its entirety.
Assessing quality, however, remains a formidable challenge. The problem is that current quality assessments don’t shed much light on value. The Centers for Medicare and Medicaid Services, for example, has come out with a variety of quality assessment initiatives but these don’t actually provide much detail as it pertains to the true quality of care delivered by ambulatory surgery centers.
The end result? Consumers don’t have the information needed to make the best care choices. When choosing a surgeon, for example, consumers are pretty much left grasping at straws when trying to determine how good the surgeon is. Indeed, it is difficult to assess the quality of the surgeon’s work because consumers don’t know how many similar procedures the surgeon has performed, how many patients have died following surgery, what percentage of the surgeon’s work has to be corrected, or what percentage of patients wind up with infections following surgery.
As an ASC, however, your organization could make it easy for consumers to appreciate all that value-based care has to offer by:
Ensuring that clinicians are following best practices – and then trumpeting your success. To help guarantee that surgeons produce the best results, your ASC can prompt surgeons and other care providers to follow established, proven best practices. To do so, consider using online tools that draw upon published literature to provide the care team with an understanding of surgical best practices. From there, your organization can then document specific results. As such, your ASC could, for instance, show consumers that 90% of the patients who have been treated by a specific surgeon recover 40% faster than the average patient.
Produce the customer service that truly satisfied. In addition to providing the clinical care that will result in the best outcomes, it’s important that all staff members work together to offer the best experience possible. All staff members – including non-clinical staff who are responsible for meeting and greeting patients – need to work diligently to ensure that patients are comfortable and their needs are met at all times to create a truly satisfying experience. As such, patients will be more likely to offer positive referrals both through their in person contact with others and via various social media channels.
Provide an accurate, easy-to-digest bill. Consumers don’t only want to have confidence in the care they are receiving, they want to have confidence in the bill that they are provided with. When consumers go to the grocery store, everything is marked and they know exactly what they paid for. Increasingly, consumers are expecting to have the same experience with their healthcare providers. By using trained and experienced ASC billing staff who will use a standardized and compliant approach to coding and billing, your ASC can confidently provide accurate bills that make it possible for consumers to understand charges as well as the cost savings associated with value-based care.
By following these strategies, your ASC can not only improve outcomes, enhance the care experience and reduce costs – but do so in a manner that enables consumers to truly acknowledge and ultimately appreciate the value that is inherent in value-based care.
Written by Nader Samii, CEO of National Medical Billing Services, and Lisa Rock, President of National Medical Billing Services.
Source: Becker’s ASC Review
This post was first published May 28, 2018 and was updated July 29, 2020.