Price transparency and ASCs: 7 insights

Here are seven insights into price transparency and ASCs from the last year:

1. As of Jan. 1, ASCs have to comply with the No Surprises Act, a measure aimed to end surprise medical bills for emergency and scheduled care. Here are five  ASC requirements. 

2. The act requires hospitals to post payer-specific negotiated rates for 300 services. HHS now requires hospitals to publish 70 stipulated services and 230 others online or face a fine of up to $300 per day. Some hospitals have price tools now posted online, while others are working to comply. While ASCs are not required to post negotiated rates online, they stand to win on cost data and often have strong quality metrics as well. 

3. This year, New York City-based insurance company Oscar Health introduced a price transparency tool that allows members to compare specific expenses for procedures at ASCs, hospitals and other settings.

4. Physicians have had trouble estimating out-of-pocket expenses, according to a study published in November in JAMA Network Open. The survey found that only 52 percent of physicians accurately estimated medication costs before the deductible was met; 62 percent accurately used coinsurance information to estimate costs after the deductible was met; 61 percent accurately used copay information; and 57 percent accurately estimated costs after out-of-pocket maximum was met.

5. Last October, two physicians and a local business owner announced the opening of an ASC offering fixed pricing in Zionsville, Ind. The ASC, dubbed WellBridge Surgical, posts the prices, which owners say are 30 percent to 60 percent lower than market averages, up front on the company's website. The procedure price includes facility charge, surgeon fee and anesthesiologist fee.

6. Here's what five ASC leaders think that price transparency should look like in ASCs. 

7. Last May, Oklahoma Gov. Kevin Stitt signed into law a price transparency bill requiring healthcare providers, groups and facilities to make cash prices available to consumers for commonly provided services.

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