Commentary: Patients deserve better information about quality and price

In this Jan. 10, 2017 photo, Adrian Aoun, founder and CEO of Forward, left, gives a demonstration of a vein illumination device that uses infrared light on an Associated Press reporter at a medical office in San Francisco. After a relative suffered a heart attack a few years ago, Silicon Valley entrepreneur Aoun got an up-close look at a health-care system that he diagnosed as an inefficient and outdated mess. Now, Aoun is ready to prescribe his remedy. It's called Forward, a health-management service that charges a $149 per month, roughly $1,800 a year, to tend to all of its patients' primary-care needs. (AP Photo/Jeff Chiu)

Recently, I was honored to testify before the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee about ways that price transparency can lower health care spending and empower patients to make wise choices about the care they need.

I was invited to testify because I am the administrator of the St. George Surgical Center, an ambulatory surgery center in St. George. Like other ASCs, our surgery center specializes in providing surgeries and preventive services to patients who leave our facility on the same day they have their procedure to complete their recovery in the comfort of their own home.

In 2013, St. George Surgical Center began offering up-front procedure pricing on our website for more than 220 procedures. We believe that by offering this information, we are giving patients critical information they need to make the right choices about their health care.

St. George Surgical Center routinely offers savings of between 60 percent and 80 percent compared with other providers. As an example, we recently had a patient from Montana visit the ASC for arthroscopic knee surgery — a procedure commonly referred to as an “ACL reconstruction.” After finding our price online, he called to make sure we did not have a typo in the price. His first quote at a Montana hospital was roughly $30,000. Our listed price, which is fully “bundled” — meaning it includes all doctor fees, anesthesia and physical therapy — is $6,335.

St. George Surgical Center is not an outlier in reducing costs. Nationally, ASCs save Medicare approximately $2.5 billion each year, Medicare beneficiaries $1.5 billion each year and private payers almost $40 billion every single year.

These savings are generated by procedures performed in the ASC instead of a hospital outpatient department. For example, in 2018, the Medicare payment rate for cataract removal in a hospital outpatient department is $1,926.09. In an ASC, the same procedure is reimbursed at $991.95.

Clearly, the demand for price transparency is real. But price is only one factor in determining value. To be meaningful, lower prices must be combined with high-quality care and a safe patient environment.

The ASC community is concerned that, in terms of measuring quality to determine value, there is little uniformity across settings. Disparities in reporting nationally and between states make it impossible for patients to compare quality and outcomes between care providers.

In Utah, fortunately, health care facilities are required to report several adverse events within 72 hours. The state then compiles the aggregate data and publishes an annual report through its Patient Safety Surveillance and Improvement Program. In comparison, 13 states do not require any adverse event reporting, and some states that collect data do not make it publicly available.

In my testimony, I urged our senators to support the following initiatives to create a more transparent and efficient health care system:

  • Medicare and insurers should publicly post information about prices paid or the beneficiaries’ out-of-pocket liability for procedures across all healthcare settings.

  • Patients should be provided information on providers in their area, including health outcomes, patient satisfaction, beneficiary cost-sharing and reimbursement to those facilities, in an easy-to-understand manner.

  • Medicare, insurers and other payers should encourage beneficiaries and the physicians who refer patients to use lower-cost settings.

ASCs believe that this patchwork reporting system needs to change. ASCs have transformed the outpatient experience by offering a convenient, personalized and lower-priced alternative to hospitals. If we are to truly empower patients to get the best value for their health care dollars, price and quality data must be transparent, meaningful and comparable across all settings where comparable care is available.

Ty Tippets is the administrator of the St. George Surgical Center.

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