ASCs are becoming an increasingly popular site of service for patients, and payers are taking note.
UnitedHealthcare's 2023 site-of-service policy, which went into effect last April, is one effort from payers that could push procedures to the ASC setting.
Here are four reasons payers are looking to ASCs:
1. Convenience
As the "shopping era" of healthcare continues, patients and payers are looking to ASCs for the convenience they provide to patients compared to hospitals.
"Providing procedures on an outpatient and/or short-term hospital stay basis encourages patients to recover in a home or rehab setting, allowing them to be with family and/or an environment focused on recovery to reasonable self sufficiency," Paula Autry, CEO of Leadership DNAmics, told Becker's last year.
Health systems are following suit. Last year, Ascension said it plans to invest more money into its ASCs, imaging and physical therapy sites that advance its footprint of service offerings and provide greater convenience to consumers.
2. Cost:
Medical procedures can cost as much as 58% more at HOPDs when compared to a physician office or ASC, according to an analysis by Blue Health Intelligence, the Blue Cross Blue Shield Association's data analytics company. Colonoscopy screenings cost 32% more in a hospital than in an ASC, according to the same analysis.
Additionally, the average cost of a knee arthroscopy with cartilage removal at an ASC is $3,412, compared to $5,226 at an HOPD, according to data from Sidecar Health's care price calculator.
"Commercial will be pushing more to the ASC in an effort to reduce costs, but not necessarily at a benefit to the ASCs if declining reimbursements are not addressed," Marietha Silvers, RN, administrator of the Surgery Center of Cleveland, told Becker's last year.
3. CMS procedure approvals:
CMS is continuing to approve more procedures in the ASC setting. In November, the agency added 11 procedures to the ASC-covered list that were not included in the proposed rule, including total shoulder arthroplasty.
"We thank CMS for heeding our request to move additional surgical procedures — including total shoulder arthroplasty — onto the ASC payable list," Ambulatory Surgery Center Association CEO Bill Prentice said in a news release. "Doing so benefits both Medicare beneficiaries, who now have a lower cost choice for the care they need, and the Medicare program itself, which will save millions of dollars as volume moves to the high-quality surgery center site of service."
4. Value-based care opportunities
As the healthcare industry moves toward bundled payments, ASCs could be in the perfect position to adopt value-based care because of the cost-efficient procedures offered in the outpatient setting.
"As healthcare reimbursement models shift from fee-for-service to value-based care, ASC leaders must focus on delivering high-quality outcomes and patient satisfaction," Ali Ghalayini, administrator at Munster (Ind.) Surgery Center, told Becker's in September. "Centers that can demonstrate efficient and effective care delivery while maintaining excellent patient experiences will likely be rewarded. Therefore, tracking and improving key performance indicators such as infection rates, patient-reported outcomes, readmission rates and patient satisfaction scores are essential. Collaborations with payers and accountable care organizations to align incentives and performance goals can be advantageous."