Press Release  HPC EXAMINES MASSACHUSETTS AMBULATORY SURGICAL CENTERS LANDSCAPE

BOSTON — Today, the Massachusetts Health Policy Commission (HPC) released a new issue of the DataPoints series, Trends in Ambulatory Surgical Centers (ASC) in Massachusetts. This analysis of the ASC landscape in Massachusetts includes the location and services provided by ASCs, utilization among commercial and MassHealth patients, prices in ASCs compared to hospital outpatient departments, and the regulatory context that has shaped the ASC industry in the Commonwealth.

ASCs are freestanding facilities that provide surgeries and other low-risk procedures to patients who do not require an overnight stay, otherwise typically performed in a hospital outpatient department (HOPD). Available evidence suggests that safety and quality at ASCs are comparable to, and in some cases better than, at HOPDs for similar patients.

Massachusetts has fewer ASCs than most states. The Commonwealth has the fourth fewest ASCs per capita nationally, at eight ASCs per million population compared to a national average of 18 per million, likely due to historical regulatory barriers to entry.

Lower ASC prices result in lower patient cost sharing. The HPC found procedures performed in ASCs are lower-priced compared to the same procedures performed in HOPDs, primarily due to lower facility payments in ASCs. ASCs may also offer patients more convenient locations, shorter wait times, and potentially lower patient cost sharing.

The HPC found that in the commercial population, total prices for common surgeries ranged from 27% to 57% lower in ASCs than HOPDs in 2021, and these lower prices tended to result in lower patient cost sharing for commercially-insured patients. For example, the average cost sharing for a colonoscopy with polyp removal was roughly 12% lower in ASCs, while cost sharing for cataract surgery was 7% lower in ASCs than in HOPDs.

ASCs are used less often by MassHealth patients. Among procedures routinely performed in both ASCs and HOPDs, the vast majority are performed in HOPDs for both commercial and MassHealth patients. However, ASCs are less frequently utilized by MassHealth patients than commercial patients. For GI procedures, a common ASC service, commercial patients had 27% performed in an ASC (versus a HOPD), while MassHealth patients had 10% performed in an ASC. Potential drivers of the difference could include provider referral patterns, patient time or ability required to research options, and location accessibility.

The findings were presented at a meeting of the agency’s Market Oversight and Transparency (MOAT) policy committee, and a recording of the meeting can be found on the HPC’s YouTube page. The interactive DataPoints dashboard and presentation materials from the MOAT meeting are available on the HPC’s website.

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