The American Association for Accreditation of Ambulatory Surgery Facilities addressed a recent Kaiser Health News and Washington Post article about health insurance plans excluding outpatient surgery coverage.
AAAASF encourages state and federal legislators to roll back these plans.
"With more than 20 million patient procedures in the AAAASF dataset, there are reliable statistics showing sequalae and mortality rates lower than the inpatient setting, said Foad Nahai, MD, AAAASF president. "In fact, CDC found on any given day about one in 25 hospital patients has at least one healthcare associated infection for a total of 721,800 infections in 2011. About 75,000 patients with HAIs died while hospitalized. Given the recent emphasis on HAI and the increased exposure to illness patients face because of the hospital inpatient population, these cost saving measures may increase postoperative compliance requiring more corrective treatment and expense."
The article states health plans don't discriminate between settings for outpatient surgery and office-based surgery center settings, ambulatory surgery centers and outpatient hospital departments are all subject to coverage exclusion in some plans. The coverage exclusion is meant to provide a solution for employers who can't purchase more robust plans for employees or pay government penalties.
But driving more care inpatient could have clinical and cost implications for patients.
"If physicians and patients migrate back to inpatient care, the delayed treatment resulting from having to wait for the hospital OR to become available would further degrade the patient's condition and force him or her to take time off of work," said Dr. Nahai. "Restraining access to care will degrade the general wellness of the U.S. patient population and result in more expensive inpatient care."
The outpatient setting typically costs less than the inpatient setting for procedures and could reduce the out-of-pocket expenses for employees.