As patient consumerism continues to make waves throughout healthcare, patient demands for pricing information are steadily increasing.
Becker's ASC Review asked nine administrators and surgery center leaders for their thoughts on price transparency.
Note: Responses were edited for style and clarity.
Question: Does your ASC make pricing information publicly available or plan to do so in the future? Why or why not?
Taylor Cera, administrator of Orthopaedic Surgery Center in Boardman, Ohio: Yes, we do make pricing information publicly available. We've been posting our pricing since 2014. We did this because it simplifies the entire process. It's a low-cost, efficient process.
Lori Tamburo Martini, director of operations at Foothills Surgery Center in Boulder, Colo.: In Colorado, the Transparency in Healthcare Prices Act went into effect on Jan. 1, 2018. As a result, Colorado ASCs are required to publicly post the self-pay prices for their top 25 procedures. Foothills Surgery Center, [managed by Lakewood, Colo.-based Pinnacle III], is among many facilities in Colorado who post self-pay rates on their websites. While this initiative aims to provide more information for healthcare consumers to make decisions, there is still potential for inexact comparisons among surgery centers because other entities may contribute to the total cost of surgery, like physician fee, anesthesia fee and lab fees, among others. It is important to remember prices posted by ASCs do not reflect the total financial obligation for the surgery. For Pinnacle III ASCs, posted prices are solely for the facility portion. Charges from other entities are not included in the posted price. At Foothills Surgery Center, our financial counselor contacts each patient prior to surgery to confirm their financial obligation. If a patient views a surgery price on the website, we recommend they contact the facility to confirm the price of their surgery.
Pierce Nunley, MD, orthopedic spine surgeon at Spine Institute of Louisiana in Shreveport: On one hand, transparency is good, but on the other hand it can create confusion that is not helpful for patients. [For example,] being a commercial pilot, a similar analogy would be the prices of seats on a plane. For an international flight on a 747 the price of a ticket can be anywhere from $200 to $20,000. Many factors are involved. There is no way that the average person can understand the complexity of the pricing system for commercial airlines. Medicine is similar.
The airline needs a mix of rates to stay viable. They simply can’t accept the lowest rate and continue to fly the plane. There wouldn't be enough money for fuel to make it to the destination.
The same is true of professional fees and ASC fees.There are some contracted rates that are nearly break-even or negative, but those are balanced with better contracts and some full-rate reimbursements that balance out for most ASCs to make a reasonable profit for running a complex business. It is unfair for the government to expect that there be set rates or that the rates be published so that patients get 'sticker shock' and have a negative opinion about pricing when they don’t have the knowledge or ability to understand the complexities of billing/collecting and expenses of an ASC.
Mitchell Schwarzbach, administrator of Grand Valley Surgical Center in Grand Junction, Colo.: I have been working with Clariti as an add-on to our practice management system. They are working on being able to have a patient log in through our website, put in their carrier, put in their ID number, pull the procedure from a drop-down [menu], and the potential patient would get what their outstanding deductible is, what their copay would be, implants and extras, along with a bottom line, or what will they need to write a check for. How cool would this be for an ASC?
Fiona Stephan, administrator of Vanguard Surgical Center in Maywood, N.J.: Our chargemaster is not online but is located at the surgical center and is available to all.
JoAnn M. Vecchio, administrator and CEO of Ambulatory Surgery Center of Western New York in Amherst: Our ASC currently does not make pricing information available. Until our patients have a better understanding of their own healthcare plans, it would just cause more confusion at this time. While the current ambulatory patient demographic is becoming increasingly educated, in terms of cost and options for their treatment, it is difficult to say how well a surgical price list would be understood. Our ASC does provide any and all upfront and out-of-pocket cost estimates to the best of our ability. Until there is a fail-safe way to verify deductibles preoperatively in real time and give an exact estimate, even this process sometimes falls short of 100 percent accuracy. With the growth of self-funded plans, we will have to plan for the possibility of making pricing public and for the real possibility of having a full-time specialist to be able to explain the pricing information.
Suzi Walton, administrator at Ohio Surgery Center in Dublin: We currently schedule with service codes; we are in the process of refining these to be more specific to allow for less manual tweaking of the CPT codes before estimation generation. We have just branched into the Catalyst product that allows anyone, any time to access an estimate for our top pediatric services, all areas [where] we are hoping to grow business. It returns an estimate that is catered to their insurance, surgery and remaining benefits to help them anticipate their out-of-pocket costs to be able to price shop.
We are currently working to expand the services listed for self-service in Catalyst and are working with Clariti to incorporate the full cost of service that includes anesthesia and the surgeon fee as well.
Christine Yoder, MSN, RN, senior vice president of operations at U.S. Digestive Health in Exton, Pa.: We do not publish pricing information, but we do share it with patients who are determined to have a financial responsibility. We do this by phone about a week or so prior to the procedure so patients are aware. It can be difficult in gastroenterology to determine an exact expected price because of the frequency with which a procedure changes from screening to diagnostic and different payer policies on that subject.
Becky Ziegler-Otis, administrator of Ambulatory Surgical Center of Stevens Point (Wis.): We do not currently make ASC pricing information publicly available; however, we plan to do so in the future.
We currently are providing our patients with their out-of-pocket estimated costs. This has been well-received and has positively impacted upfront collections. There is growing demand from patients to be aware of their upfront cost and expense so they can adequately plan for the expenses.
We are working toward making our surgical center's pricing available on our website. It would be depicted as "cash-based" pricing, similar to the manner displayed by the Free Market Oklahoma Surgical Center. Patients who have high deductibles and chose not to use their insurance plan may find this is of great benefit, along with patients who prefer to pay cash for their healthcare services. Price transparency demonstrates the center's commitment to providing cost-effective, quality surgical services.
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