'Half the cost, half the risk' at ASCs versus hospitals — Dr. Shakeel Ahmed makes the case for upheaving referral patterns

Costs and infection rates. Those are two healthcare measures made more important than ever by the COVID-19 pandemic — and they're also two areas where ASCs have hospitals beat by a long shot, according to Shakeel Ahmed, MD, CEO of Atlas Surgical Group.

"ASCs were the need of the time for the last 10, 20 years. ASCs are a necessity now," Dr. Ahmed told Becker's ASC Review. "Healthcare is bleeding money, and what comes to the forefront is healthcare savings. … ASCs can save up to $40 billion a year in healthcare costs if elective cases are moved to outpatient settings."

Moreover, studies have shown the rate of healthcare-associated infections in ASCs is just a fraction of the rate for hospitals, Dr. Ahmed said. A CDC study he cited from 2009 revealed that about 8.95 patients per 1,000 developed a surgical site infection in the hospital setting, compared to just 4.84 in 1,000 patients who had surgery in an ASC.

These are the points Atlas Surgical Group wants to get across on a new billboard advertisement, which is meant to draw patients back after elective case restrictions and amid ongoing virus concerns.

"Scared of hospitals? Choose a surgery center. Half the cost. Half the infection risk," the billboard reads, listing Atlas Surgical Group's locations in St. Louis, O'Fallon, Ill., and Fairview Heights, Ill.

Explaining the rationale behind the advertisement to Becker's, Dr. Ahmed compared what common procedures cost at ASCs versus hospitals. Knee arthroscopy is about $900 to $1,000 in an ASC, compared to over $2,000 in a hospital. Lumbar fusions cost $5,000 in an ASC and roughly $11,000 in a hospital. And an even simpler procedure — a colonoscopy — is about $300 in the ASC, and more than twice as much in a hospital, Dr. Ahmed said.

"Hospitals set prices without negotiation because they know insurers will pay rates at least twice as much as ASCs with no greater value. In fact, they offer less value, for double the price; they expose these patients to twice the risk of infections," he said. "That's what the billboard states."

As for federal COVID-19 relief doled out to hospitals, Dr. Ahmed acknowledged that many deserved it for their instrumental role in fighting the pandemic.

"Our point of view on this is we are an ancillary service to hospitals," he said. "Patients are unsafe in hospitals for now. Generally speaking, they're better off in a clean setting like an ASC. Hospitals always have survived — they will [this time] — but we can't afford to continue to lose money in this manner in the long term."

Rather than the COVID-19 relief funding, Dr. Ahmed's issue is with the long-standing trend of primary care physicians referring patients to hospitals when they can get high-quality, low-cost care at ASCs instead.

With their bonuses and salaries coming from hospitals — and the unspoken risk of retribution for referring patients to non-hospital facilities — primary care physicians "are almost coerced into referring patients [to hospitals], knowing these services are two times or three times as expensive" as ASC services, Dr. Ahmed said.

That's why Dr. Ahmed encourages patients to ask their primary care physicians three questions:

1. Are you directly or indirectly employed by the hospital you're referring me to?
2. Am I going to pay double for those services at a hospital versus an ASC?
3. If so, why?

Hospital administrators may take issue with the nature of these questions, claiming to encourage non-ASC referrals and charge more because hospitals handle indigent and emergency cases, Dr. Ahmed said.

Dr. Ahmed doesn't buy into that reasoning, in part because of his own experience. In its latest certificate-of-need application process, Atlas Surgical Group showed the Illinois Department of Public Health that its ASCs in southern Illinois together see 60 percent of local Medicaid patients.

It's why the group was able to obtain a CON for its O'Fallon ASC, Dr. Ahmed said. It's also yet another reason hospitals should "rightfully refer patients to ASCs" — or better yet, partner with ASCs.

"A joint venture or partnership between hospitals and ASCs brings out the best of us," Dr. Ahmed said. "It breaks my heart that patients have no idea about the differences in price and infection rates. They'll go where their doctors ask them to go. We need to appeal to the good sense of PCPs and referring doctors."

By appealing to these physicians — who took an oath to do no harm — Dr. Ahmed believes the healthcare system can change for the better.

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