Becker's ASC Review

63 Shining a Light on the Value of Value-Based Care ASCs are positioned to lead the way By Nader Samii, CEO, and Lisa Rock, President of National Medical Billing Services C onsumers are now paying for a greater percentage of their healthcare bills. e average annual out-of-pocket costs per patient rose almost 230 percent between 2006 and 2015, according to a report from the Kaiser Family Foundation. 1 In addition, more employers are offering high-deductible health plans than ever before. In fact, the number of employers offering HDHPs grew from just 23% in 2016 to 44% in 2017 in the education industry, 41%in 2016 to 51% in 2017 in retail, 48% in 2016 to 54% in 2017 in manufacturing and 55% in 2016 to 61% in 2017 in manufacturing, according to a study from Benefitfocus. 2 ese consumer-focused plans are resulting in the cost savings that they were designed to produce–sort of. Consider the following: A study published in the American Journal of Managed Care found that consumer-directed health plans have resulted in a $231.60 reduction in annual outpatient spending for members. Interestingly, however, the study also found that members in these high-deductible plans used about the same amount of low-value imaging, laboratory tests and procedures as their counterparts in traditional health plans. 3 With value-based care now entering into the equation, this should all change. Under value-based models, healthcare providers are increasingly reimbursed based on the quality of care achieved, not just the volume of services delivered. As such, providers will realize financial rewards that are tied to specific quality outcomes and could subsequently eliminate some low-value services. While the model makes perfect sense in theory, real-life challenges abound. More specifically, healthcare providers including ambulatory surgery centers (ASCs) are struggling to assess cost and quality data in tandem – making it difficult to acknowledge whether value- based equations compute. is, in turn, is making it difficult for consumers to recognize and realize the benefits associated with this emerging care delivery model. ASCs to the rescue? Ambulatory surgery centers (ASCs), however, could help value- based care move out of the ivory tower and into the real world. Fortunately, ASCs are perfectly positioned to deliver on the model's promise. ASCs have been intentionally developed to provide cost-effective, quality care from the get-go. Indeed, ASCs are held to an extremely high standard and many are oen solely focused on performing certain types of surgeries, thus the surgeons and supporting surgical team are well versed in specific procedures and their required safety protocols. is oen leads to a more focused approach with fewer variables, leading to fewer complications and lower infection rates. 4 Infection rates following surgeries performed at outpatient surgical centers, for example, are relatively low, according to a study published in the Journal of the American Medical Association. e study found that 3 out of every 1,000 patients who undergo surgery at ASCs are treated for surgical cite infections at 14 days post-op, a rate that increases to nearly 5 out of every 1,000 patients at 30 days post-op. 5 By comparison, surgical site infections in hospitals have been reported to occur in 2%, or 20 out of every 1,000 patients. 6 ASCs, however, need to not only deliver quality care at a reduced cost, they need to prove that they are doing so as well. To that end, many healthcare providers are starting to post prices for various procedures on their websites. e practice is actually mandated by a number of states. Cost or price information really is of little value if it can't be ingested along with quality information, though. Imagine that a patient has hernia surgery and chooses the lowest cost surgeon to perform the procedure. e patient, however, winds up in the emergency department two weeks aer the surgery – and has to undergo a subsequent procedure. e cost savings is now negated, as the care experience will cost much more in its entirety. Assessing quality, however, remains a formidable challenge. e problem is that current quality assessments don't shed much light on value. e Centers for Medicare and Medicaid Services, for example, has come out with a variety of quality assessment initiatives but these don't actually provide much detail as it pertains to the true quality of care delivered by ambulatory surgery centers. e end result? Consumers don't have the information needed to Under value-based models, healthcare providers are increasingly reimbursed based on the quality of care achieved, not just the volume of services delivered. As such, providers will realize financial rewards that are tied to specific quality outcomes and could subsequently eliminate some low-value services.

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