Samaritan helps members find quality surgical care

Surgery can be scary, even something like routine hip or shoulder surgery.

• You’re away from home.
• You’ll have medical bills to deal with.
• You may even have trouble finding a good provider.

Samaritan Ministries helps its members find great care by connecting them with an ambulatory surgery center (ASC) and making the sharing process easy.

“ASCs focus on same-day surgical procedures and therefore do not have the overhead expense of a hospital, generating significant savings—in some cases over 50% vs. the local hospital—without compromising quality of care,” said Rob Bordeaux, Samaritan Ministries Provider Relations Specialist.

Samaritan Ministries calls this initiative Care Compass, which helps members find a good direction—in some cases, literally—to go for planned surgery.

Over the next few months, we will post lists of ASCs to which Samaritan guides members according to specialty, giving their location and current cost, starting this month with hip surgery and following up with

• ACL surgery
• shoulder surgery
• knee surgery
• hernia surgery
• colonoscopy

Members expecting the need for outpatient surgery can get more information by calling Samaritan’s Provider Relations department at (877) 764-2426, Ext. 7082, or sending an email to [email protected].

Advantages of ASCs

ASCs offer many benefits to patients over standard hospitals. The most obvious is they are more affordable.

"Hospitals have to pay for having 24 hours' worth of care, even if you don't need it for an outpatient basis." Rob said. "So, surgery centers aren't paying for 24 hours' worth of care for staff, professional staff, etc."

But there are many other advantages to ASCs. They also have:

• a lower risk of infection
• more individualized care
• pleasant surroundings, sometimes including a meal provided after the procedure

Another advantage for Samaritan members is that using a Care Compass provider or recommended local provider may result in their Initial Unshareable Amount and any future prorated amount for that need waived if they receive more than $1,500 in shareable care from that provider.

Care Compass provider requirements

In order for an ASC to qualify as a Care Compass provider, it must:

• be independently owned by the surgeons who practice there
• offer bundled pricing for surgical service that is quoted up front with no negotiation is necessary
• post bundled pricing on its website or offer pricing to members when they contact the ASC
• have a concierge service to assist with scheduling appointments, gathering medical records, scheduling telemedicine consultations with the surgeons, and provide a statement up front with surgical expenses

“It’s got to be as easy as I pick up the phone, I make a phone call, and they take care of everything,” Rob said. “We also want the physicians to be owners or part-owners because they control the quality of care and service. We want them to have a hand in it.”

If an ASC helps with hotel reservations and transportation, that is a nice addition. Samaritan also looks at whether the ASC requires upfront payment. Most ASCs require payment in full prior to surgery, but the upfront services team can assist with options.

How Care Compass works

If a member has to travel for the surgery, then the ministry’s Care Compass program can help with expenses, since the overall cost would likely still be less than a traditional surgery setting. Samaritan offers members who travel more than two hours from their home to an ASC for their procedure a $300 per diem. Members can determine their means of travel and how they want to use the $300 daily allotment. No receipts are required, either, so that’s less paperwork.

Most people will need surgery and other procedures at some point in their lives, and Samaritan tries to make it easy and low-stress for our members.

We hope the information we’ll be presenting over the next few months will be useful if you need to have some kind of routine joint surgery or a colonoscopy.

Read here about ASCs that offer hip surgery.