The costs of ASCs versus hospitals
According to a new report by the Workers Compensation Research Institute, ambulatory surgery centres (ASCs) are less expensive for certain surgeries than hospitals.
“Some studies indicate that ASCs provide care that is less expensive than services provided in hospitals,” said Ramona Tanabe, WCRI’s Executive Vice-President and counsel. “This analysis is important since evidence about ASC surgeries from other payors (Medicare or group health insurance) may not apply in workers’ compensation settings.”
The report, which covers 14 US states, found that payments for knee surgeries done at ASCs were at least 21-per-cent lower than payments for hospital outpatient surgeries in 2016. Payments were found to be similar in three states, while in Indiana, payments for ASC surgeries were found to be 59-per-cent higher than payments for hospital outpatient surgeries.
The authors of the study, Dr Bogdan Savych and Dr Rebecca Yang, examined payments to ASC and hospital outpatient departments by looking at the most common groups of surgeries conducted in outpatient settings — knee and shoulder arthroscopies. The study shows information on all payments to ASCs and hospital outpatient departments within a surgical episode but excludes payments to surgeons or other medical professionals.
According to the authors, the differences in payments for ASC and hospital outpatient surgeries may be attributed to multiple factors, such as a state’s fee schedule regulations, network participation rates, or negotiated prices. For example, in Indiana, payments for hospital outpatient surgeries are reimbursed at 200 per cent of Medicare after the adoption of a hospital fee schedule in 2014, while payments to ASCs remain unregulated.