The Biden administration and Congress have made multiple efforts to crack down on “Surprise Medical Bills” to protect patients from exorbitant out-of-network bills during emergency services. These efforts are a positive step, but are incomplete. Patients are still frequently surprised and frustrated by outpatient fees that differ markedly between standalone facilities and hospital-owned outpatient departments. Congress must equalize site-of-service payments to protect patients from arbitrarily higher costs and to help put Medicare on a more sustainable funding path.
Outpatient care consists of office visits, testing, and procedures that do not involve an overnight hospital stay. These encounters can occur at hospital outpatient facilities or at physician-owned facilities, like doctors’ offices or Ambulatory Surgery Centers (ASCs). When doctors order diagnostic tests or procedures, they usually think they are acting in the best interests of their patients by sending them to an affiliated facility. However, many doctors, like their patients, are unaware that site-of-service for outpatient procedures has a dramatic effect on the costs patients pay. Enforcing existing price transparency laws would give consumers more control over their personal health care expenditures, create more free market choices, and encourage patients to receive their outpatient care in more efficient and affordable settings.
ASCs have been a major disrupter to the status quo. Competing with hospital outpatient surgical departments, ASCs have increased the scope of procedures that can be safely done with better efficiency, cost accounting, and a lower cost of care. State lawmakers should increase competition and lower costs by repealing ASC “Certificate of Need” laws and state restrictions that prevent them from performing all procedures approved by the Centers for Medicare and Medicaid Services (CMS).