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IPG is both a pioneer and a leader in working with health plans to use value-based contracting as a means to address escalating device and site-of care (SoC) surgical costs. With no cash outlay in this model for the device, the provider can perform the procedure in the lower cost ASC setting, benefiting the facility, health plans and members. The benefit is that the member receives one claim, but the downside is that unlike the savings created in Option 1, health plans do not participate in device pricing benefits and it creates significant cost pressure on the plan due to the shift of price leverage onto the bundled holder. Additionally, the provider must outlay the cash for the device, which often causes cherry picking of procedures, sending high-cost procedures to the higher cost HOPD, while having health plans pay significantly more facility-based charges on more routine procedures.
A review of commercial medical-claims data found that U. S. healthcare costs are reduced by more than $38 billion per year due to the availability of ambulatory surgery centers (ASCs) as an appropriate setting for outpatient procedures. More than $5 billion of the cost reduction accrues to the patient through lower deductible and coinsurance payments. This cost reduction is driven by the fact that, in general, ASC prices are significantly lower than hospital outpatient department (HOPD) prices for the same procedure in all markets, regardless of payer.
Pacira CEO David Stack says 70% of surgeries will be outpatient in 10 years Here are the key drivers Mr. Stack said he sees the move to outpatient surgery as an important driver for the company’s success in the future. The company estimates around 70 percent of surgeries are done in hospitals and 30 percent are done in ASCs; however, over the next 10 years Mr. Stack projects that will flip to 70 percent of surgeries performed in an outpatient or ambulatory setting and 30 percent in the inpatient hospital.
Blue Cross NC and IPG Collaborate to Reduce Surgery Costs Through Cost and Quality Transparency