ASCs Making an Effort to Be Price Transparent

ASCA’s latest survey shows

BY ALEX TAIRA | SEPTEMBER 2023

ASCA’s August 2023 60-Second Survey asked questions regarding facility provision of price estimates to patients. The survey received 160 responses from surgery centers in 39 states.

Survey Results

Overall, 91 percent (146/160) of survey respondents attested to their facility having a public website. This question might seem elementary but publishing prices on a consumer-facing website has been a primary element of price transparency requirements. One-hundred percent (56/56) of respondents whose facility has any level of hospital ownership have a website, while solely physician-owned ASCs are slightly less likely to have a public website (85 percent).

When asked what information was available on the facility website, a list of clinicians who operate in the ASC was noted as the most commonly available element. Almost 70 percent (87/130) of surgery centers responded that their website contains a list of common procedures performed at the facility. Only 20 percent (26/130) attested to providing price information for common procedures on their website. Despite this, 91 percent (131/144) of survey respondents said that their facility has a standard workflow for providing estimates to patients prior to a procedure. Interestingly, facilities with any level of hospital ownership are slightly less likely to have a standard price estimate workflow (89 percent) compared to facilities with physician ownership (92 percent).

The payer-negotiated rate is by far the most common basis for price estimates that 77 percent (93/121) of survey respondents use. About 12 percent (14/121) of ASCs use the procedure cash price and only 7 percent (8/121) use the procedure gross charge. The majority of facilities that provide a cost estimate prior to procedures include the patient coinsurance amount (83 percent) and relevant HCPCS/CPT codes (78 percent). Less than half (34 percent) include ICD diagnosis codes and very few (11 percent) list National Provider Identifiers (NPI) as part of cost estimates. A few facilities indicated providing additional information including deductible status, procedure time or anesthesia information.

Background

The modern policy discussion around healthcare price transparency began in earnest with the Affordable Care Act (ACA). Section 2718(e) of the ACA instituted a new requirement that hospitals make public a list of “standard charges for items and services” as part of a larger effort to bring down the cost of healthcare coverage. However, lack of action by the federal government left the requirement dormant until 2019 when the Centers for Medicare & Medicaid Services (CMS) established that beginning January 1, 2019, hospitals must make a list of their standard charges available via the internet in a “machine-readable format.” Despite this specification, compliance remained haphazard leading the Trump administration to take a series of actions culminating in a new final rule defining price transparency of hospital standard charges that would take effect on January 1, 2021. Similar requirements that apply to health insurers and group health plans would take effect the following year.

Although no similar rule regarding disclosure of pricing for standard charges has been promulgated for ASCs, discussion around price transparency policies continues heavily in 2023. In early September, a group of committees in the US House of Representatives introduced the Lower Costs, More Transparency Act. This bill included a proposal that would require ASCs to publish standard charges for each item and service furnished by the ASC. The bill was pulled from the House floor without a vote on September 18, but signals a strong desire by federal legislators to extend price transparency oversight. It should be noted that ASCs are currently subject to requirements under the No Surprises Act, which requires facilities to provide a “good faith estimate” of expected charges for uninsured or self-pay patients.

A nonprofit, Patient Rights Advocate, surveyed 2,000 hospitals and found that only 36 percent are in complete compliance with price transparency rules. This led CMS to further refine hospital requirements in the CY 2024 Hospital Outpatient Prospective Payment System (OPPS) proposed rule. CMS is proposing to strengthen enforcement capabilities and continue standardization of the form and format with which hospitals display standard charges.

ASCA introduced the 60-Second Survey, a bimonthly survey series, in spring 2021. As the name suggests, each survey takes 60 seconds or less to complete and asks fewer than 10 questions on a current topic. The topic changes survey-to-survey, but each aims to take the pulse of the ASC community and help ASCA better serve its members and the ASC industry at large.

Write Alex Taira for questions about this survey or to propose topics for future surveys.