Using surgery centers helps to keep costs low

By Barry Clark  ·  Jun 20, 2023

Every day at Samaritan Ministries, the Provider Relations team works heartily unto the Lord for our members. They steward member Share dollars by pursuing fair prices for medical bills that members submit.

One way the team accomplishes this is through direct negotiation of medical bills with the provider. And to do this most effectively, the Provider Relations team has been developing relationships with providers directly in order to gain provider trust and to share strategies with you on how to choose providers that are high quality and have a fair price.

One target area in achieving greater success in getting quality service at a fair price is increased member use of ambulatory surgery centers (ASCs).

ASCs are care sites that offer surgical procedures, diagnostics, and preventive care services, according to the Ambulatory Surgery Center Association. These sites are different than provider offices, rural health care clinics, urgent care facilities, or ambulatory care centers.

A quick online search revealed more than 8,000 ambulatory surgery centers in the U.S., most of which can be found through Healthcare Bluebook™.

How they save

Why is ASC usage a key focus in our effort to contain member costs? A 2021 research study by the UnitedHealth Group1 reveals that:

  • The average price of common procedures performed in a hospital outpatient department in 2019 was $7,716. The average price in ASCs was $3,157.
  • This price difference represents an opportunity to reduce costs of a procedure by an average of 59 percent.
  • A significant 90 percent of outpatient procedures are strong candidates for ASC usage, while only 10 percent are more suited to a hospital due to complex medical conditions, often unrelated to the actual procedure being performed.

Samaritan member experience in choosing ASCs over traditional hospital outpatient services parallels this cost information.

We shared one example with you in our February newsletter. Samaritan member Leighton Greenberg broke his arm in a high school basketball game. A plate was inserted into Leighton’s arm, but then needed to be removed surgically once the arm had healed.

His parents, Troy and Rhonda, already knew that it paid to look for fair pricing, and they found WellBridge Surgical in Indianapolis, Indiana. WellBridge’s price was 76 percent—$11,325—off a hospital’s price. (See typical savings at WellBridge in the chart on page 13.)

What you can do

Actively pursue using ASCs in your area. Be aware that many surgeons perform procedures at multiple facilities, and the price at an ASC is often substantially lower than when performed in a hospital.

Look for ASCs that provide upfront, all-inclusive pricing. These bundled prices include physician/surgeon, anesthesiology, facility, and miscellaneous fees.

Travel program

In addition, If you cannot locate a fit provider in your area, consider Samaritan Ministries’ pilot medical travel incentive program (MTIP) if you need to find care outside your area.

The MTIP pilot program provides:

  • $1,000 Share credit for using MTIP-eligible ASCs.
  • $300 per diem (approved pretravel days and procedure days) Share credit to help with travel, lodging, meals, etc.

Currently there are two eligible ASCs for this pilot program, with more to be added in the future:

Here’s how the MTIP works:

  • Contact the Provider Relations team by sending an email to [email protected] or calling them through 877-764-2426. We will guide you in obtaining a local estimate for the surgery and also an estimate from WellBridge Surgical or the Surgery Center of Oklahoma. (Find prices on their websites.)
  • Once you send this information in, it will be reviewed by our Provider Relations team, and they will advise you how to proceed.
  • The surgical centers will be in contact with us, and we will advise them if the procedure is approved for sharing. If it is approved, we will send a check straight to the surgical center. (Additional bills will be shared for the member if needed.)

And that’s it! Samaritan Ministries will add the credit to your membership, your approved travel will be shared, and you will receive a fair price reward of $250.

More often than not, ASCs are high-quality alternatives to hospital outpatient procedures and they save substantial amounts of money. The next time you have a need for this type of medical procedure, strongly consider local ASC options and the medical travel incentive program.

Barry Clark is manager of Provider Relations at Samaritan Ministries.