Updated: March 30, 2021
Recent legislation impacts this issue in significant ways. ASCA will release new information soon. If you need additional assistance before that information becomes available, please contact Kay Tucker.
By William Prentice, published in Morning Consult, March 13, 2019
Thanks to new technologies that allow us to easily share our experiences on social media and ratings platforms, consumers today have unprecedented access to price and quality information on an enormous range of products and services. With just a few taps on a smartphone, we can access everything we need to know to buy a new dishwasher or hire any number of professional services with confidence.
However, when it comes to the one service that everyone should know more about — our health care — little is understood and even less is shared about the actual cost and quality of services. That needs to change.
There is significant variation in the price of health care within virtually every market in the country, often with little or no measurable difference in the quality of services or medical outcomes. Rather, patients often wrongly assume that paying more assures a better outcome.
It’s true that some insurers, as well as several other companies that collect and analyze payments to providers, are making more information available for patients who are motivated to look and learn. Just recently, Medicare also began requiring hospitals to post prices publicly and launched a “Procedure Price Lookup” tool that allows Medicare patients to compare prices, as well as copayments, for certain procedures that are performed in both hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC). But the vast majority of health care consumers today are still choosing services and procedures with little or no upfront knowledge of the costs they will incur.
That’s why providers and facilities such as ASCs need to offer greater price transparency to patients before they undergo a service or procedure. This is becoming increasingly important as more Americans enroll in high-deductible health plans or pay out-of-pocket for a greater percentage of their health care costs. Both hospitals and ASCs need to find better ways to make this information available to patients to help them make informed decisions about their care.
Providers and health care facilities also need to be more transparent about the quality of their services, but finding common ground on the metrics that accurately constitute quality remains a challenge. HOPDs, ASCs and doctors’ offices all have different reporting requirements at both the state and federal level. And, the information we currently collect is not easily accessed or particularly informative to patients.
“Patient satisfaction” surveys are probably the most widely used data points that a variety of providers collect, but they are often not the best indicator of quality since they often rely on the patient’s personal experience (i.e., “Everyone was friendly”) rather than their clinical results (i.e., “I can walk without pain”). The questions used in these surveys also vary widely, making the results hard to use to discern differences between providers.
ASCs, which I represent, know just how difficult it is to develop a meaningful quality reporting program. Our association has been working with the Centers for Medicare & Medicaid Services for more than a decade to develop a system for reporting quality measures for Medicare patients who receive care in ASCs. While we have made some progress, much more needs to be done to make the reports accessible and user-friendly to patients.
For example, under current regulation, ASCs are required to report when a patient’s medical condition requires him or her to be transferred from an ASC to a hospital.
While we support use of this reporting requirement, we believe the reports would be far more valuable if they included a reason for the transfer that would help consumers differentiate between transfers that may have resulted from surgical complications and transfers that occurred because a patient presented a risk factor unrelated to their scheduled procedure, such as an irregular heart rate.
The ASC community would support having providers of similar services — such as HOPDs and ASCs — collect the same quality data on specific procedures, so that patients could make an “apples to apples” comparison about where to get their care. CMS, too, supports the collection of data that patients can use to compare providers and acknowledges the need to make quality reporting more useful to patients.
Few, if any, expenditures in our lives are as important and essential as our health care — and that’s why we owe it to patients to provide better, more useful information about the cost and quality of care available to them. ASCs are ready to do their part, and we hope others are, as well.
William Prentice is the CEO of the Ambulatory Surgery Center Association.