Patients anticipating outpatient surgical procedures can save both out of pocket and insurance costs without compromising safety or quality. Outpatient surgery centers fall into two categories, Hospital Outpatient Surgery Departments (HOPD) and Ambulatory Surgical Centers (ASC). HOPD’s, as described, are the outpatient surgery departments owned directly by hospitals generally located on hospital campuses. ASC’s may be associated with hospitals, but are separate facilities that could be completely independent. Prescott Outpatient Surgical Center (POSC) is an ASC that is majority owned and managed by a group of active, local surgeons. The difference is important when it comes to healthcare costs.
If a needed procedure is appropriate for an outpatient setting, patients can choose where to have it done. The surgeon and anesthesia provider are paid the same wherever they perform the surgery. The facility can offer significant savings. ASC’s typically offer savings of at least 50%. The only way to verify costs is to ask the facility for quotes/estimates before scheduling.
As an example, recently one of POSC’s surgeons priced facility costs for a patient without insurance. POSC quoted $7,000 (including anesthesia). The surgeon’s scheduler informed us that they were quoted $32,000 by an HOPD. Not all differences will be that substantial.
If these prices represented what an insurance company would pay each facility, savings to the patient would still be significant. Assuming a deductible of $5,000 and a maximum patient out of pocket cost of $11,500, in both scenarios the patient would pay the first $5,000. If coinsurance was 20%, the patient’s total out of pocket cost at the POSC would be $5,400. That jumps to $10,400 at the sample HOPD.
Patients don’t have to compromise safety or quality to achieve these savings. Quality factors such as infection rates and professionalism are equal, if not higher in most ASC’s. At POSC, scores range consistently between 9.7-9.8 out of 10.
Conclusion: If outpatient surgery is needed, evaluate available facilities based on quality and price, especially if deductibles of and out pocket maximums are significant. It could result in significant healthcare savings.