Last year, CMS began requiring hospitals to post prices negotiated with private insurers online and enforced compliance. The agency is also requiring insurers and health plans to disclose in-network provider rates by July 1. Both policy changes could be a boon for ASCs.
Surgery centers are not required to post negotiated rates online as of yet, but typically they are the low-cost setting for surgical services. ASCs stand to win on cost data and often have strong quality metrics as well. As a result, price transparency could also make certificate of need laws obsolete.
These laws, which exist in 35 states, were implemented to prevent overutilization and overbilling of healthcare services. The process is rigorous and can block surgeons from opening ASCs, especially if hospitals or other entities oppose them.
However, with transparent pricing, contracted rates are out of the shadows. Armed with pay rate and utilization information, potential owners likely are not going to open facilities in areas where they cannot make money.
Hospitals likely will not easily give up the influence certificate of need laws afford them, but it will become harder to justify their existence.