UnitedHealth Touts ASC Savings, But Are There Drawbacks?

by Leslie Small

A newly published report from UnitedHealthcare makes a strong financial argument for moving routine, non-complex medical procedures — such as a gallbladder removal — from hospital outpatient departments to ambulatory surgery centers (ASCs).

UnitedHealth makes its case:

• UnitedHealthcare examined claims data from the insurer's employer-sponsored plan members during the 12 months ending February 2020. Of the 6 million routine outpatient procedures that were performed in hospital outpatient departments for this population, 56% involved non-complex patients who had an ASC within a short distance from their homes. If such patients were to choose an ASC as their site of care, it would reduce the cost of routine procedures by an average of 59% — saving consumers $684 on average per procedure, according to the report.
• Those estimated cost savings are attributable to the fact that surgeries performed at ASCs are well-known to be cheaper than those taking place at a hospital. According to the UnitedHealthcare report, the average price of common procedures performed in a hospital outpatient department in 2019 was $7,716, or 144% more than the average price of the same procedures performed in ASCs.

But it may not be that simple:

• "ASCs can be more cost-effective for some patients — particularly those who are healthy, have few co-morbidities, and are low-risk," notes Joe Paduda, principal of Health Strategy Associates LLC.
• However, "the problem arises when hospitals — which are required to have those emergency capabilities on hand and accessible at all times — lose those patients," Paduda says. "Think of this as similar to 'adverse selection' in the insurance world; if ASCs skim off the healthy patients, hospitals are left with the more expensive/more complicated ones, which drives up their operating costs, and further increases patients'/insurers' costs."
• In addition, there are disparities in the use of ASCs, suggested a study published in the JAMA Surgery journal in 2020. In their study of 13 million patients who received ambulatory surgery in New York and Florida between 2011 and 2013, researchers found that "the likelihood of receiving surgery at a freestanding ambulatory surgery center compared with a hospital-based outpatient department was significantly lower among patients who were Black, had public health insurance, and resided in rural areas."

From Health Plan Weekly