Employers and consumers could save billions by shifting more surgeries out of hospital outpatient settings to ambulatory surgery centers, according to a new study by Healthcare Bluebook.
Commercial payers save $38 billion annually when patients get care in ASCs, Healthcare Bluebook found. Patients could save another $41 billion if they had their surgeries performed in ASCs rather than in hospital outpatient facilities and the savings required no sacrifice in quality, the study showed.
The American Hospital Association questioned the study's methodology.
Healthcare Bluebook arrived at its conclusions by analyzing private health insurance claims data. The study was done in cooperation with the Ambulatory Surgery Center Association and HealthSmart, the nation's largest independent administrator of health plans for self‐funded employers.
Healthcare Bluebook received no funding for the study and did it to benefit clients, including HealthSmart, said Bill Kampine, Healthcare Bluebook co-founder and senior vice president of analytics.
Hospitals tend to charge more for surgeries in their outpatient departments than ASCs because of higher overhead in some cases and negotiating leverage with commercial payers in others, Kampine said.
Knowledge of the price disparity could allow employers and insurers to design plans to encourage the use of ASCs, he said. That is especially important in an era of high-deductible plans that are making consumers pay more out-of-pocket for care, he said.
The study found that patients' out-of-pocket costs at ASCs are reduced by more than $5 billion annually through lower deductible and coinsurance payments. He said employers could save money simply by having employees use the delivery network “more efficiently.”
Physicians, in consultation with patients, play a big part in where surgeries are performed and they often are seeing patients with higher-acuity in the hospital outpatient setting, said Tom Nickels, AHA executive vice president for government relations and public policy.
“ASCs generally do not provide care to uninsured patients,” Nickels said in a statement. “Hospitals see more Medicaid and dual-eligible patients than ASCs. Hospitals also have significantly greater regulatory requirements than ASCs.”
He said the study, which was done in collaboration with the ASC industry, “fails to account for these important distinctions.”
The Ambulatory Surgery Center Association represents more than 5,400 ASCs.
The new study echoes the findings of a 2014 study that used Medicare data to look at the cost disparities between surgeries performed at ASCs and hospital outpatient departments. That study was conducted by health economists Elizabeth Munnich of the University of Louisville and Stephen Parente of the University of Minnesota.