ASCA’s Bill Prentice on the Need for Cost Control in Medical Care

Expert Interviews

Ambulatory Surgery Centers (ASCs) have been a major component of the push towards value-based care in the US healthcare system. The Scope spoke with Bill Prentice, J.D., CEO of the Ambulatory Surgery Center Association, a trade non-profit that assists ASCs in delivering safe, high-quality, cost-effective patient care.

Prentice outlines below his vision for further value-based care, the role ASCs have played and will play in that vision, and the need for more robust cost control and transparency in medical care.

(Answers edited for style and length.)

What innovations in the last 1-3 years do you feel will permanently change the healthcare industry and why?

Lasting innovation in healthcare does not often happen overnight and is typically built on years of experience and testing. Three of the most important developments in healthcare that have allowed ASCs to provide the kind of top-quality, cost-effective, patient-centric care they offer today are the advances in technique, technology, and pain management we have seen over the last decade and longer. Procedures that once required weeks-long hospital stays can now be performed safely and with comparable or improved patient outcomes as same-day procedures.

Patients looking to avoid inpatient hospital stays, cut costs, and recover in the comfort of their own homes overwhelmingly prefer outpatient surgery. Insurance providers, and employers that pay for some or all of their employees’ health insurance plans, also prefer the cost-effective care and top-quality outcomes ASCs provide.

Who (organizations or people) are the most meaningful disruptors in healthcare today and why have others failed?

ASCs have been in existence for only 50 years, and during that time, they have been one of the biggest disruptors of traditional healthcare delivery systems over many decades. Thanks to the patient-focused care, top-quality outcomes and cost savings they deliver, ASCs have driven demand for surgery in the outpatient setting among both patients and physicians.

While it would be impossible to pinpoint one simple reason other ideas have failed over the years, one of the reasons ASCs have succeeded is that they deliver exactly what they promised: high-quality, cost-effective care that puts patients first.  

What areas of healthcare do you think are most in need of change?

Two areas — cost control and quality transparency — continue to be challenging for the healthcare community. While the ASC community cannot provide a comprehensive solution to controlling every cost associated with healthcare, ASCs have a long history of saving Medicare and its beneficiaries money. In 2018 alone, Medicare patients who decided to have the outpatient surgery they needed in an ASC instead of a hospital outpatient department reduced Medicare program costs by $4.2 billion. ASCs have the ability to save Medicare and its beneficiaries more and, even without additional policy changes that could be adopted to move more outpatient surgical procedures into ASCs, are projected to save Medicare $12.2 billion in 2028. ASCs save private insurers even more.

[Full studies that provide the information in the preceding paragraph are available at https://www.advancingsurgicalcare.com/reducinghealthcarecosts/costsavings/reducing-medicare-costs and https://www.advancingsurgicalcare.com/reducinghealthcarecosts/costsavings/healthcarebluebookstudy ]

When it comes to quality measurement and reporting, ASCs have long been asking for and working toward a system that would allow patients and others to make meaningful comparisons between providers who deliver the same type of care instead of the patchwork set of quality measures in place today. Current quality measures and reporting systems provide for limited insights into individual providers and only rare comparisons between providers.

At the same time, healthcare policy makers need to work to make sure that all patients in need of outpatient surgery have access to the care they need in the site of service that is most appropriate for them, including the high-quality, lower-cost ASC environment.

What does value-based care mean to you? Can you provide us some examples in action?

ASCs are the definition of value-based care—they are a way to cut the cost of surgery while delivering outstanding patient outcomes and customer service. Value is a combination of cost and quality. ASCs offer both, plus, a level of customer service and convenience almost any product or service provider would want to provide.

What are the biggest challenges and obstacles to making your vision of a value-based care future a reality?

One of the barriers that prevents Medicare beneficiaries from taking advantage of the value that ASCs provide is inadequate payments for certain procedures, especially those requiring expensive implants. Another obstacle is a reluctance to move new kinds of procedures into ASCs even when ASCs are already performing these procedures safely for privately insured patients.

For privately insured patients, failed contract negotiations that prevent ASCs from providing in-network care can prevent patients from enjoying the many benefits ASCs provide.

Where do you like getting your industry news from? Which industry thought leaders do you listen to and why?

For expertise on ASCs, we routinely rely on our members. In general, people outside the ASC community do not have the same understanding of the ASC model of care and everything involved in managing an ASC successfully.