Image by ugzka from PixabayMore patients want to know exactly what they’ll owe before entering the operating room, and ambulatory surgery center (ASC) operators are paying attention.
Some are bringing facilities in-house to simplify billing while others are posting prices online. Many are finding new ways to give clearer estimates upfront.
At the same time, some proposed transparency laws could end up doing more harm than good, creating administrative headaches without actually helping patients make better decisions, ASC leaders caution.
For many surgery centers, true price transparency begins with control over the surgical setting itself.
Ownership enables clarity
TriaVision, a Birmingham, Alabama-based eye care group, is preparing to open a two-operating-room ASC in Jefferson County after securing Certificate of Need approval in May 2025.
With that facility under its control, the group expects to offer more straightforward pricing for a range of services, including premium cataract procedures that are not fully covered by insurance.
“It is more difficult to give a price when we are performing the surgery in a facility that’s not ours,” Amanda Moorefield, vice president of operations at TriaVision, told Ambulatory Surgery Center News. “That lens is … typically purchased by the facility.”
Patients are often surprised to receive multiple bills for the same procedure, particularly when they opt for self-pay options like laser-assisted surgery or advanced intraocular lenses, Moorefield said. These enhancements fall outside typical insurance coverage and can lead to confusion when billing is split between the physician and a third-party facility, she added.
“There’s this breakdown of communication that can happen, not always, but with some groups and some facilities where the patient doesn’t know that a second bill is coming,” Moorefield said. “They have the surgery and they think they are done, and then the facility sends a bill afterwards.”
TriaVision’s new ASC will allow the group to deliver bundled, up-front pricing with no surprises, she said.
“We will know concretely upfront what our self-pay prices are for both a professional fee and the facility fee,” Moorefield said. “Having an in-house facility really helps us to provide price transparency.”
Even when insurance covers part of the procedure, having the facility in-house makes it easier to communicate the patient’s expected portion, Moorefield explained.
“We certainly can provide estimates for what the insurance is covering and what the patient would pay for their portion as well,” Moorefield said. “We have a record where we can look back and see what these different payers will reimburse and what they have reimbursed in the past.”
Self-pay menus online
Coastal Orthopedics, a surgery center based in Bradenton, Florida, has taken a direct-to-consumer approach. The center publishes its self-pay pricing online, giving patients an easy way to see what procedures cost without having to make a phone call or request a quote.
“We have an entire self-pay package that’s available for any patient to view online anytime,” Dr. Daniel Lamar, orthopedic surgeon and physician president of Coastal, told ASC News. “Folks who don’t have commercial insurance or Medicare can see the prices very specifically.”
Lamar said being upfront about pricing not only helps patients plan for procedures but also builds trust between providers and the community.
“I think that would help everyone to really understand where these dollars are being spent and how they’re being spent,” Lamar said. “It may help inform future decisions about how to better spend those dollars.”
Confusion sometimes arises when patients see the billed charges on insurance statements and do not realize that those are not the actual payments providers receive, he said.
“There’s been a lot of challenging conversations with patients to help them understand these numbers that you see are real,” Lamar said. “This isn’t what we get paid.”
While some practices are still cautious, technology is making transparency easier to implement and maintain, the ASC leader continued.
“You can’t hide from it,” Lamar said. “You better embrace it.”
Concerns about one-size-fits-all legislation
While many ASCs are taking steps to increase transparency voluntarily, some operators worry that pending legislation could impose costly and unnecessary requirements.
In several states, lawmakers are considering bills that would require binding estimates for surgical procedures, even when the specifics of those procedures cannot be known until surgery begins.
Peter Lohrengel, executive director of the North Carolina Ambulatory Surgery Center Association, said the proposed laws do not reflect the reality of surgical care.
“If you had an MRI to diagnose your shoulder, we still don’t know what’s wrong going into surgery,” Lohrengel said. “Until we get in there, we don’t know if it needs tendon sutures, hardware anchors, or what level of repair is necessary.”
Lohrengel said requiring binding estimates in those situations could compromise patient care – and force providers to choose between quality and reimbursement.
“It creates a whole bunch of decision dilemmas that would have to play out,” Lohrengel said. “That’s never been the practice of anyone in health care.”
He also warned that such legislation could add significant administrative costs.
“If it took an hour to develop each estimate, and your surgery center sees 6,000 patients a month, how much money are we talking about?” Lohrengel said. “We’ve seen this go into needing to add two full-time staff to a surgery center, and they’re not minimum wage staff.”
And most patients are primarily interested in what they will owe out of pocket – not in what the insurance company will reimburse the provider, Longhrel said.
“ASCs always tell the patient what they’re going to need to pay for the procedure in advance,” Lohrengel said. “The rest is between the provider and the insurance company.”
The risk is that overly prescriptive rules could add cost without delivering benefits, he said.
“The patient received an estimate they never wanted,” Lohrengel said. “They had the same co-pay regardless. Why make everyone receive it?”
The push to stay ahead
For Moorefield, the key to meeting transparency expectations is internal coordination.
That includes managing both the professional and facility side of the bill, educating patients about their options, and being prepared to offer concrete numbers early in the care process, she said.
“When the whole episode of care is under one roof, we can speak confidently to patients about exactly what they’ll pay,” Moorefield said.
ASCs that embrace transparency will be better positioned to compete in an increasingly consumer-driven market, Lamar said.
“Technologies allow us to deliver a lot of that information pretty efficiently,” he said. “I certainly think it’s coming in every capacity.”
ASCs are not opposed to transparency, but they want legislators to recognize what they are already doing and avoid forcing operational changes that do not improve patient care, Lohrengel said.
“We’re already very transparent,” he said. “What we’re asking is, let us continue to do it in a way that’s efficient and effective for our patients.”
