Non-Hospital Surgical Centers Cheaper, But Rare

The Health Policy Commission released a new analysis on Thursday, Feb. 15, 2024 on ambulatory surgical centers in Massachusetts.  (Health Policy Commission)

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The volume of ambulatory surgical centers that perform same-day, low-risk procedures in Massachusetts falls far below the national average, according to new data shared with state health regulators Thursday.

The free-standing facilities, referred to as ASCs, typically offer lower prices compared to hospital outpatient departments. Massachusetts, which is home to 58 centers licensed by the Department of Public Health, has the fourth fewest centers per capita among all states, with only Virginia, West Virginia and Vermont trailing behind the commonwealth, according to an analysis shared by the Health Policy Commission.

The research, part of HPC's work to examine pricing structures in various medical settings, prompted members of the Market Oversight and Transparency policy committee to contemplate how establishing more centers here could potentially change the commonwealth's health care landscape and cut costs. Committee Chair Dr. David Cutler questioned whether more centers could possibly reduce the number of hospitals or in-patient settings that are needed in Massachusetts.

"The concern of 'is there going to be a supply-induced increase in demand for total services,' I think, has not really borne out in other states," Sara Sadownik, HPC's deputy director of research and cost trends, said during a meeting Thursday afternoon. "It's more of a substitution."

Patient quality and safety at the centers is comparable or sometimes better than the care delivered at outpatient hospital departments, the HPC said.

Massachusetts has 23 ambulatory service center operating rooms per 1 million residents, compared to the national average of 56, according to the data.

The limited number of centers is partially fueled by regulatory hurdles, including a former Department of Public Health regulation -- which is no longer in effect for new locations -- that blocked ASCs from being situated within 15 minutes an acute care hospital, said HPC senior researcher Katya Fonkych said.

Massachusetts would need to more than double its number of centers to reach the national average, Sadownik said.

Lower prices at the centers translate into lower patient cost sharing, Fonkych said.

In 2021, common surgeries at the centers cost 27 to 57 percent less compared to services in hospital outpatient settings, the HPC said. The average cost sharing for a colonoscopy with polyp removal, for example, was about 12 percent less in ASCs compared outpatient hospital departments.

But fewer MassHealth patients use ASCs compared to patients with commercial insurance, according to Fonkych. Officials said more research is needed to understand the disparity.

Patients' time and ability to research different care options could explain the difference, as well as location accessibility, Fonkych said.