Chief Executive Officer, Ambulatory Surgery Center Association
What is ASCA’s position on recent calls from both Congress and the Administration for greater quality and price transparency across the healthcare system?
ASCA supports greater transparency in the healthcare system and believes patients need and deserve access to user-friendly price and quality information in order to make better choices for their healthcare.
To help achieve this goal, ASCA voluntarily asked the Centers for Medicare & Medicaid Services (CMS) to create a national quality reporting program for ambulatory surgery centers (ASCs), and we are now in the sixth year of collecting and reporting quality information to CMS. It is also clear, however, that more work needs to be done to make the information more accessible and understandable to patients.
For instance, quality data is kept in separate silos by provider type, making it hard to compare ASCs, hospital outpatient departments (HOPDs) and physician office-based outpatient surgery providers. A more useful system is needed so that patients can compare sites of care in a single database.
ASCA also believes more needs to be done to make provider pricing information more accessible to patients, such as adding community-level price information to the CMS Price Comparison Tool.
What is ASCA’s position regarding “surprise billing?”
Most of the concerns about surprise billing relate to hospital emergency room charges, which are, obviously, outside ASCA’s purview. In some cases, however, when out-of-network providers deliver care inside an in-network ASC, patients can receive a surprise bill.
ASCA believes surprise bills—and the unexpected burdens they place on patients—can and should be eliminated through a combination of better upfront disclosures, improvements in network adequacy and a mandatory arbitration process for insurers and providers.
When procedures are performed in ASCs, patients deserve to know in advance what health services are covered by their insurance and what, if any, non-covered or out-of-network charges, such as anesthesia, laboratory or pathology charges, are possible. ASCs have a role to play in alerting patients to the potential for out-of-network charges but do not have access to the insurance network information needed to inform patients about exactly what those charges would be. Only the patient’s insurer or the provider of those services has access to that information.
In June, the President issued an executive order that included the establishment of a “Health Quality Roadmap” that aims to align and improve reporting on data and quality measures across providers. Will this roadmap help outpatient surgery patients get the information they need?
There is no question that quality reporting—for all healthcare facilities and providers—needs to improve. While a great deal of progress has been made, much more work needs to be done to make the information that is being collected more accessible to patients and more useful in making comparisons between different sites of service. A well-managed program for all providers that includes common quality measures, aligns inpatient and outpatient measures, wherever possible, and eliminates low-value measures—goals this program aims to achieve—would go a long way toward building an online tool that could help patients requiring outpatient surgery make informed choices about where to have the care they need.
What additional steps could Congress take to resolve surprise billing disputes?
ASCA strongly supports proposals intended to remove patients from the middle of billing disputes.
One possible solution that offers significant promise is arbitration since it (1) takes the patient out of the process, (2) allows for input from both the provider and the insurer and (3) requires resolution in a timely manner. For bills above a certain threshold, arbitration would allow both the provider and the insurer to submit proposals for amounts they consider fair, and a third-party arbiter would select the best offer. That decision would be binding on both parties.
Can you explain ASCA’s support for greater “network adequacy” and how it could improve competition and pricing for outpatient surgical procedures?
At the community level, many health insurance networks simply do not offer patients an adequate choice of providers, even when there are multiple local providers willing to participate in their networks. There are several reasons why this continues to occur.
Unlike hospital systems that are often the only provider in a market for certain inpatient services, many ASCs have little or no negotiating power with insurance companies. In some instances, that lack of negotiating power has made it difficult, if not impossible, for ASCs to negotiate fair, market-based rates of reimbursement that would allow them to become in-network providers.
In other instances, hospital networks have actually inserted language into their agreements with insurance carriers that prevent them from contracting with multiple providers. When that happens, it is clearly intended to restrict competition, frequently from lower cost providers, and we believe that’s harmful to patients. Consequently, ASCA has called for a prohibition on any language that restricts an insurer’s ability to contract with multiple healthcare providers.