UASCA Q&A Forum
What is the Utah Ambulatory Surgery Center Association?
- The Utah Ambulatory Surgery Center Association (UASCA) currently represents surgery centers and physicians across the state of Utah.
What are Ambulatory Surgery Centers (ASCs)?
- Surgery centers are affordable, accessible, and safe facilities for outpatient surgical treatment.
- Surgery centers feature high nurse-to-patient ratios, an absence of cost-shifting and virtually no infection rate (less than .3%).
- Utah ASCs are approved and accredited by the state’s Department of Public Health and Environment, the Joint Commission on Accreditation of Health Organizations (JCAHO), and the Accreditation Association for Ambulatory Health Care (AAAHC).
- Surgery centers are cost effective. Prices are low and billed charges are clearly delineated for the patient.
Are surgery centers the same thing as specialty hospitals?
- No. Specialty hospitals are facilities in which in-patient procedures are performed. The current moratorium on specialty hospitals does not involve surgery centers.
What are UASCA’s goals at the state level?
- To ensure that surgery centers remain in place as affordable and accessible alternatives for outpatient surgical care in Utah.
- To play a supporting role in efforts to make our health care system more transparent, cost-effective and accountable for Utah’s consumers.
- To educate policy makers about the achievements inherent to the surgery center model of care and to maximize surgery center utilization in efforts to achieve costs savings in Medicaid and Medicare.
- To collect and analyze data to support an informed public dialogue about the role of surgery centers in our health care delivery system.
What are UASCA’s goals at the federal level?
- To support advocacy efforts initiated by the ASC Association.
- To investigate the current trend by insurance companies nationally and locally to exclude ASCs from viable contracts.
- To advocate a repeal of the current freeze on Medicare reimbursement rates for ASCs.
- To shed light on problems with the existing Centers for Medicare and Medicaid Services list of ASC-approved procedures and to urge the replacement of a separate ASC list with a system of parity between ASCs and Hospital Outpatient Departments (HOPDs).
- To contribute new ideas and perspectives to the ongoing dialogue concerning the role of surgery centers in the nation’s health care delivery system.
What is an ASC?
- An Ambulatory Surgery Center (ASC) is a facility where surgeries that do not require hospital admission are performed. However, ASCs are held to many of the same standards as hospitals. For example they are required to be licensed to operate and must be certified by Medicare.
What is the difference between hospitals and ASCs?
- ASCs offer equipment and a fully trained staff of doctors, nurses, and technicians who perform various procedures on a same day basis.
- Cost is lower compared to most hospitals for both patients and insurance companies.
- ASCs provide a pleasant, intimate atmosphere in which the patient can relax and feel comfortable.
- These smaller, more private facilities are conducive to visits from family and friends.
- Patients are asked to make one payment to the surgery center.
- Outpatient surgery is less stressful.
- Scheduling is more predictable.
What you should consider in choosing an ASC:
- The reputation and quality of the center.
- The center’s ability to access emergency equipment.
- The center’s level of follow-up care.
- The center’s location.
- The type of communication that will be available to your health professional.
- Your insurance coverage.
What do ASCs provide?
- They provide a cost-effective and convenient environment that is less stressful than what many hospitals offer.
- They perform high quality health care at lower costs compared to hospitals due to the fact that they can maintain low overhead costs and because they can focus on one thing: treating ambulatory patients efficiently.
- They are conveniently located for patients due to being smaller and easily accessible to patients.
- They are also able to improve efficiencies which reduce patient waiting time.
- ASCs offer better-quality outcomes, due to staff specialization. The physicians are able to tailor surgerical suites to their specialty and operating style.
- They are more affordable for patients and for payers because of the lower cost.
- They also provide technology advancements.
- The operation they offer is the most appropriate procedures for outpatient surgery are those associated with post-operative care that is easily managed at home, and those with very low rates of post-operative complications, requiring care by a physician or nurse.
What are outpatient services?
- Outpatient services are medical procedures, surgeries, or treatments that are done in a qualified medical center without the need for overnight stay.
- Many outpatient service centers specialize in a specific area of medicine.
- Outpatient surgery eliminates inpatient hospitals, reduces the amount of medication prescribed, and use a doctor’s time more efficiently.
What you should ask your doctor before having surgery:
- What operations are you recommending?
- Why do I need the operation?
- Are there alternatives to surgery?
- What are the benefits of having the operation?
- What are the risks of having the operation?
- What if I don’t have this operation?
- Where can I get a second opinion?
- What has been you experience in doing the operation?
- Where will the operation be done?
- What kind of anesthesia will I need?
- How long will it take me to recover?
- How much will the operation cost?
What you should expect from surgery:
Before surgery:
- Most surgery centers have a before-surgery form for you to fill out from 1 to 3 days before your surgery.
- The surgeon evaluates the person before operation.
- Depending on the surgery, your physician may order certain test to help determine your overall health.
- Your surgeon may include other doctors in your care, depending on your medical conditions.
- Many surgery centers have a nurse who will meet with you or call you at home a few days before your surgery.
- The surgeries held in the surgery center are usually minor and take around 2 hours and allow you to recover at home.
- Before your surgery your nurse of surgeon will give you a list of reminder of what you can or cannot do which usually includes not drinking or eating anything before surgery, specific information regarding medicine, not wearing jewelry or make-up.
During surgery:
- This is known as the intraoperative period.
- A special surgical team will help the surgeon with your surgery. They are trained to provide you with safe care during your surgery.
After surgery:
- Surgery is never risk free. So after your surgery your surgeon will review all the risk related to your surgery.
- Instantly after surgery, you will be taken to a recovery area where a nurse will care for and observe you. Your vital signs and bandages will be checked as well as your pain levels.
- For most minor surgeries, the nurse will encourage you to be as active as possible to prevent problems.
- You will need to drink fluids without vomiting, be upright without fainting, and urinate on you own before you will be sent home.
- You will receive special instructions from your surgeon; you will go home with a sheet of care instructions.
- Your surgeon will also set up a time for you to come see them again.
- Be sure to call your surgeon if you an unexpected symptom or problems.
What are the cost differences between hospitals and ASCs?
- Prices are low and billed charges are clearly delineated for the patient.
- ASCs are more affordable for patients. According to the Medicare Payment Advisory Commission, Medicare payments to ASCs are lower than payments to hospitals for comparable services for 87 percent of procedures.
- Additionally, patients pay less coinsurance for procedures furnished in the ASC environment than for comparable procedures in the hospital setting. For example, a Medicare beneficiary would typically pay a hospital $496 in coinsurance for a cataract extraction procedure, whereas that same beneficiary’s co-payment for an ASC would be only $195; a Medicare beneficiary would typically pay a hospital $186 in coinsurance for a colonoscopy, whereas that same beneficiary’s co-payment for an ASC would be only $89.
- By having surgery in the ASC the patient may save as much as 61% or over $300 compared to their out of pocket coinsurance for the same procedure in the hospital.
- ASCs are also more affordable for payers. Studies have shown that the Medicare program would pay approximately $464 million more per year if all procedures performed in an ASC were instead furnished at a hospital.
- Medicare saves almost half a billion dollars by utilizing ASCs instead of hospital outpatient departments.
- Private insurance companies tend to save similarly, which means that employers also incur lower health care costs by utilizing ASC services. Employers and insurers, particularly managed care entities, are driving ASC growth in many areas, because they recognize the efficiencies and savings inherent in ASC settings.