The proliferation of ambulatory surgery centers (ASCs) has not led to a decrease in hospital outpatient surgery department prices, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ).
The study examined ASC growth and revenues using a large national claims database that contains information on actual prices paid. The author found that for six common outpatient surgical procedures, prices paid to ASCs remained stable during 2007–2012, while prices paid to hospital outpatient surgery departments (HOPSDs) for the same procedures increased sharply. The six procedures were:
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cataract surgery with intraocular lenses;
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colonoscopy;
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knee arthroscopy with debridement;
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knee arthroscopy with meniscectomy;
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post-cataract surgery;
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upper gastrointestinal endoscopy.
The study also found that private insurers paid ASCs more than Medicare paid ASCs for the same procedures. Medicare pays ASCs a legislated percentage of what it pays HOPSDs for the same services, but there is a considerable discrepancy between this ratio and the ratio of payments by private insurers across provider types and procedures, AHRQ said.
“These findings question the use of a single ratio for ASC payments to HOPSD payments and suggest that ASCs and HOPSDs do not currently compete on price,” according to AHRQ. “The findings support the argument for increased price transparency and narrow or tiered insurance network designs that reward high-value providers.”
The study was published in the October issue of the journal Health Affairs. To access the abstract, go to http://1.usa.gov/1PAyeFQ.
