Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments

2016 ◽  
Vol 74 (2) ◽  
pp. 236-248 ◽  
Author(s):  
Kathleen Carey
Keyword(s):  
Health Care ◽  
Surgical Procedures ◽  
Price Competition ◽  
Ambulatory Surgery ◽  
Market Penetration ◽  
Ambulatory Surgery Centers ◽  
Hospital Outpatient ◽  
Efficient Delivery ◽  
Outpatient Departments ◽  
The Impact

Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

scholarly journals Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida

2017 ◽  
Vol 10 ◽  
pp. 117863291770102 ◽  
Author(s):  
Robert L Ohsfeldt ◽  
Pengxiang Li ◽  
John E Schneider ◽  
Ivana Stojanovic ◽  
Cara M Scheibling
Keyword(s):  
Ambulatory Surgery ◽  
Private Insurance ◽  
Multivariable Logistic Regression Model ◽  
Ongoing Research ◽  
Ambulatory Surgery Centers ◽  
Hospital Outpatient ◽  
Hospitalization Rates ◽  
Outpatient Procedures ◽  
Outpatient Departments ◽  
The Impact

Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery.

Retinal Surgery in Ambulatory Surgery Centers versus Hospital Outpatient Departments

2017 ◽  
Vol 1 (6) ◽  
pp. 563-564
Author(s):  
Harrison Sciulli ◽  
Chase W. Miller ◽  
Llewelyn J. Rao ◽  
Joan H. Hornik ◽  
Douglas Y. Rowland ◽  
...  
Keyword(s):  
Ambulatory Surgery ◽  
Ambulatory Surgery Centers ◽  
Retinal Surgery ◽  
Hospital Outpatient ◽  
Outpatient Departments

scholarly journals Cost Calculation Methodology Exacerbates Site-of-Service Differentials by 10- to 18-Fold for Soft Tissue and Joint Injections in Hospital Outpatient Departments

2017 ◽  
pp. 215-221
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Soft Tissue ◽  
Health Care Cost ◽  
Cost Calculation ◽  
Physician Payment ◽  
Ambulatory Surgery Centers ◽  
Hospital Outpatient ◽  
Calculation Methodology ◽  
Outpatient Departments ◽  
Access And Quality

In recent years, physicians and facilities have faced a multitude of reforms, regulations, and payment models to reduce health care costs, and to improve access and quality. Despite these measures, total health care cost increased to $3.3 trillion in 2016, up 4.3% from 2015. An aging population and an increase in cost are two of the factors that account for most of the increase in costs. Price intensity from physicians and facilities are influenced by Medicare rate-setting methodology with site-of-service differentials. Site-of-service differentials for payments are increasingly being recognized as a topic that requires discussion. Intraarticular and soft tissue injections are performed in physician offices (90%), ambulatory surgery centers (ASCs) (1%), and hospital outpatient departments (HOPDs) (9%), however, the payment rates differ 10- to 18-fold among these settings with 63% of total payments to HOPDs, 2% to ASCs, and 37% to offices. In this manuscript, we describe significant payment differentials, based on cost calculation methodology that indicate a potential substantial savings of more than $125 million per year if HOPDs are reimbursed at the same rate as ASCS, utilizing any of the formulas, even if the current ASC rate is doubled. This effort would also save significantly when it comes to copayments, which are 27% by patients, instead of the 20% in offices and ASCs. The addition of Medicare Advantage recipients, which constitutes approximately 30% of the overall Medicare population will increase these estimations by 30%. In conclusion, utilizing accurate payment rate calculations for intraarticular and soft tissue injections will result in substantial changes in the payment rates. In fact, just the differences in the copay itself would make the copay $66.06 (which is 27% of $244.68). This rate is 3- to 5-fold higher than the current Medicare rates for office payment or even 2-fold higher than the ASC payment. Key words: Medicare, physician payment schedules, HOPD and ASC payment schedule, site-of-service differentials, soft tissue injections, intraarticular injections

scholarly journals Saga of Payment Systems of Ambulatory Surgery Centers for Interventional Techniques: An Update

2012 ◽  
Vol 2;15 (2;3) ◽  
pp. 109-130
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care System ◽  
Ambulatory Surgery ◽  
Payment System ◽  
Payment Systems ◽  
Ambulatory Surgery Centers ◽  
Interventional Techniques ◽  
Hospital Outpatient ◽  
Interventional Pain Management

The health care system in the United States has been criticized for skyrocketing expenditures and quality deficits. Simultaneously, health care providers and systems are under pressure to provide better and more proficient care. The landscape of the US health care system is shaped by federal and private payers which continue to develop initiatives designed to curtail costs. These include value-based reimbursement programs; cost-shifting expenses to the consumer and reducing reimbursement of providers and facilities. Moreover, there is an underlying thought to steer provision of health care to theoretically more efficient settings. Many of these initiatives are based on affordable health care reform. The major aspects of curtailing health care costs include hospital and other facility payments as well as physician payments and reductions in the approved services. Consequently, ambulatory surgery centers (ASCs) are not immune to these changes. Until 1970, all surgery was performed in hospitals The development of ASCs and site of service differential payments for in-office procedures have changed the dynamics of surgical trends with outpatient surgeries outpacing inpatient surgeries by as early as 1989. By 2008, approximately 65% of procedures were performed in all outpatient settings including hospital outpatient departments. ASCs claim that improved efficiency in health care delivery allows patients to spend less time in the health care setting with quicker turn over, improving the productivity of the health care team. However, since the majority of the ASCs are owned, in part, by the physicians who staff them, the financial incentives related to ownership have been alleged to potentially alter provider behavior. The number of Medicare certified ASCs and total Medicare payments from 1999 to 2010 increased significantly, but more recent year-to-year changes are far less substantial when compared to previous years. Net percent revenue growth from 2008 to 2009 was 3.2% and from 2009 to 2010 was 6.2% with an overall increase from 1999 of 183% over a period of 11 years. Similarly, the number of Medicare certified ASCs increased from 2,786 in 1999 to 5,316 in 2010, 1.1% increased from 2009 to 2010, however, a 91% increase from 1999 over a period of 11 years. Interventional pain management is one of the fastest growing specialties with a footprint in multiple disciplines. Interventional pain management in ASC settings has come a long way since June 1998 proposed Health Care Financing Administration’s ASC rule which seriously compromised interventional pain management in the ASC setting. There are many payment challenges facing interventional pain management (IPM) in 2012. Significant changes continue to occur in the payment systems with policies of paying a certain percent of hospital outpatient department payments to ASCs which declined from 63% in 2008 to 56% in 2011, with substantial reductions for add-on codes. The Centers for Medicare and Medicaid Services (CMS) evaluation of IPM codes also consists of multiple misvalued codes. In conclusion, overall the future of ASCs may appear optimistic, but in the near perspective, specifically in 2012 to 2014, there will be challenging times specifically for interventional pain management centers with the regulatory environment and rapid changes taking place with or without implementation of Affordable Care Act. Key words: Outpatient prospective payment system, ambulatory surgery center payment system, Government Accountability Office, Medicare Modernization and Improvement Act, interventional techniques

13. The impact of government regulation of ambulatory surgical facilities on access to elective surgical procedures

2007 ◽  
Vol 30 (4) ◽  
pp. 34
Author(s):  
E. Fric-Shamji ◽  
M. Shamji
Keyword(s):  
Health Care ◽  
Surgical Procedures ◽  
Government Regulation ◽  
Ambulatory Surgery ◽  
The United States ◽  
Lumbar Discectomy ◽  
Rapid Expansion ◽  
For Profit ◽  
Elective Surgical Procedures ◽  
The Impact

Advances in medical technology have made free-standing ambulatory surgery centres a cost-effective method of delivering health care in the United States. One: Rapid expansion of such centres and duplication of services have raised concerns over rising health care costs, two: leading to government regulation of facilities via a Certificate of Need (CON) law in many states. Three: Such regulation may decrease access to elective procedures. This study investigates access to elective surgical procedures in selected states with and without CON laws. Results of the Health Care Utilization Project were analyzed. Per capita rates of elective carpal tunnel release (CTR) and lumbar discectomy were evaluated in 16 states with CON laws and 5 states without CON laws over the years 2004-2005. Distribution of CTR and lumbar discectomy were analyzed by facility ownership and teaching status, using rates of emergent procedures as a control. Student’s t-tests compared rates of CTR and discectomy as a function of CON legislation. Two-factor ANOVA extended this analysis to account for teaching environment and facility ownership. Fewer CTR cases were performed in states with CON laws (p=0.014), specifically in government-owned (p=0.012) and non-teaching facilities (p=0.01). No difference was observed in lumbar discectomy rates in states with respect to CON regulation. Distribution of both procedures among teaching and non-teaching centers was independent of CON laws. Facility ownership predicts fraction of these cases performed at an institution,(p < 0.01) and this distribution is influenced by CON regulation, increasing fractions of both types of procedures performed at private, not-for-profit centers (p=0.001, p=0.003 respectively). We conclude that CON laws restrict access to certain procedures, specifically in government-owned and non-teaching facilities. These laws may limit the supply of surgical care, notably by redistributing away from government and for-profit centres. Potential solutions include reinvestigating the need for CON laws, or examining the CON methodology to accurately reflect need. Small NC, Bert JM. Office Ambulatory Surgery Centers: Creation and Management. J Am Acad Orthop Surg 2003; 11:157-62. Casalino LP, Devers KJ, Brewster LR. Focused Factories? Physician-Owned Specialty Facilities. Health Affairs 22(6):56-67. Lanning JA, Morrisey MA, Ohsfeldt RL. “Endogenous hospital regulation and it’s effects on hospital and non-hospital expenditures” Journal of Regulatory Economics1991 (June); 3(2):137-54.

scholarly journals 144. Little evidence of same-day, oral antibiotic prescribing at ambulatory surgery centers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S83
Author(s):  
Laura M King ◽  
Lauri Hicks ◽  
Sarah Kabbani; Sharon Tsay ◽  
Katherine E Fleming-Dutra
Keyword(s):  
Surgical Procedures ◽  
Ambulatory Surgery ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Chi Square ◽  
Convenience Sample ◽  
Ambulatory Surgery Centers ◽  
National Public Health ◽  
Course Length

Abstract Background The objective of our study was to describe oral antibiotic prescriptions associated with procedures in ambulatory surgery centers (ASC) to evaluate if there are major national opportunities to improve antibiotic use in this setting. Methods We identified surgical procedures in ASCs and oral antibiotic prescriptions in the IBM® MarketScan® Commercial 2018 database, a large convenience sample of privately-insured individuals aged &lt; 65 years. We excluded visits with same-day hospitalizations and those with infectious diagnoses that may warrant antibiotic treatment. We included only antibiotic prescriptions dispensed on the same day as an ASC visit. We calculated the number of visits and oral antibiotic prescriptions and the percent of visits with oral antibiotic prescriptions overall, and by patient age group (&lt; 18 and 18–64 years), antibiotic class, and procedure type. We also calculated median antibiotic course length. Across-group comparisons were evaluated using chi-square tests. Results In 2018, 918,127 ASC visits with surgical procedure codes were captured, of which 37,032 (4.0%) were associated with same-day oral antibiotic prescriptions. The percent of visits with antibiotic prescriptions was significantly higher among children compared to adults (9.4% vs 3.8%; p&lt; 0.01); however, adults accounted for 89% of prescriptions. Respiratory/nasal and urinary tract system procedures were most frequently associated with antibiotic prescriptions (Figure). Median course length was 5 (interquartile range 3–7) days. The most common antibiotic class was cephalosporins (49.6% of prescriptions), followed by penicillins (12.6%) and fluoroquinolones (10.9%). Figure. Percent of ambulatory surgery center visits with same-day antibiotic prescriptions by procedure category, IBM® MarketScan® Commercial Database, 2018 Conclusion Only 4% of ASC procedures were associated with same-day oral antibiotic prescriptions, suggesting antibiotics are not commonly prescribed in ASCs on the day of surgical procedures. Additionally, the observed 5-day median duration may suggest that some of these courses are intended for treatment rather than prophylaxis. Our estimates represent lower bounds for oral antibiotic prescriptions in this setting, as we only captured same-day prescriptions. However, our findings suggest that ASC facilities may not be high-impact targets for national, public health antibiotic stewardship efforts. Disclosures All Authors: No reported disclosures

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