As the pay disparity between hospital outpatient departments and ASCs continues to grow, some leaders are concerned about how the chasm is driving patients to hospitals.
This will likely continue as healthcare consolidates. The vertical integration of physician groups and health systems is resulting in a push to procedures to HOPDs over ASCs, according to a study published July 25 in Science Direct.
The report found that following vertical integration, there is a 5 percentage point increase in the use of HOPDs instead of ASCs for arthroscopy and a 6.8 percentage point increase for colonoscopies.
Elaina Turner, RN, administrator of New Albany, Ind.-based Commonwealth Pain and Spine, joined Becker's, to discuss how this disparity is affecting patients.
Question: What are the long-term ramifications of the pay disparity between HOPDs and ASCs?
Editor's note: This response was edited lightly for clarity and length.
Elaina Turner: Unfortunately, ASCs have to be a for-profit entity just to keep their doors open. There's nobody coming in to save the day with handouts. Procedures that should be done in the ASC absolutely should be done there. Taking them to the hospital is the wrong move. It costs significantly more for the exact same procedure that can be done safely and efficiently in the ASC. On top of that, you have HOPDs operating like hospitals and getting paid like hospitals, but they’re essentially ASCs. The pay disparity there is massive. Some of these procedures aren't even covered an ASC, so you're forced to push those patients either back to the clinic or have them self-pay, which not everyone can afford. Even a small pain injection can be a financial burden. You're left trying to figure out some sort of charity care situation, or you just can't do it, which leaves the patient in the same condition as before. That's the biggest travesty of the whole thing.
Q: How does the disparity affect patients?
ET: If I'm a patient going to have a total knee replacement and the physician does it in the hospital — not only am I being charged more for my out-of-pocket, for my deductible, for my co-insurance, all those things, but I'm now being subjected to sick patients, because that's where they're supposed to be. I could go home with a brand new knee and a sickness because maybe I touched a handrail that somebody else touched.
If I'm in the ASC where everyone has to be healthy — we're going to cancel your procedure in the ASC if you're sick — your out-of-pocket is cheaper because the entire procedure is cheaper. The co-insurance is cheaper because the entire procedure is cheaper. Also, you're out of there faster. It's less time away from your home. It's less time for your family to take off and take care of you or sit with you in the waiting room while you wait. And you don't have that potential of being sick.