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Ambulatory Surgery Centers (ASC) Cost Factors – WCRI- Live

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Ambulatory Surgery Centers (ASC) Four State Comparison

Ambulatory Surgery Centers (ASC) Cost Factors.  Difference for same type of surgery = 300%  between the states. Neighboring states – MD and VA or NY and CT  have  large differences  in ASC charges.

Picture of Ambulatory Surgery Centers Wilford Hall
Wikimedia Commons – Dwayne Snader

Fee schedule states ASC’s usually charge less.  Variability of ASC charges in the same state is greater in non-fee schedule states

Injured workers actually have the same experience whether they have surgery in hospital or ASC.  

Four states were compared that had similar fee schedules.   There was little variability in costs  among the ASC’s in these four states.  Could that have been due to the states being in the same region?

ASC differs cost factors differ greatly across states due to fee schedules.   States with fees schedules had a greater level of predictable costs than states without fee schedules.   In fact, most states with fee schedules allowed for a higher level of predictably of charges. 

Network penetration rates are much lower for ASC’s  even though the surgeon is actually in-network.   This situation happens often in health insurance where the doctor is in-network but many of the associated physicians are not in-network with the insured bearing the brunt of the additional costs. 

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

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  • Bloomberg Business News
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  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
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