AAAASF Addresses Health Insurance Plans that Exclude Outpatient Surgery from Coverage

Share Article

Following publication of a recent article, AAAASF encourages legislators and regulators in all states and at the federal level to take action to roll back such plans

Dr. Foad Nahai

Restraining access to care will degrade the general wellness of the U.S. patient population and result in more expensive inpatient care.

On Jan. 25 Kaiser Health News and the Washington Post featured an article discussing employer health insurance plans that exclude outpatient surgery from coverage. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) sees this failure to cover outpatient surgery as a shortsighted attempt to address cost and a stark and troubling development for a number of reasons.

Now entering its 36th year, AAAASF promotes the highest quality patient safety in the ambulatory surgery setting (office-based or outpatient) and rehabilitation and outpatient therapy agencies, as well as rural health clinics. AAAASF encourages legislators and regulators in all states and at the federal level to take action to roll back such plans.

Based on the Jan. 25 article, the health plans in question do not discriminate between the settings for outpatient surgery. Office-based surgery settings, Ambulatory Surgery Centers and hospital outpatient departments are all subject to these exclusions, attempting to provide a viable solution for employers who can neither purchase more robust plans nor pay government penalties. However, the exclusion carries potentially serious implications for health care quality, according to AAAASF President, Dr. Foad Nahai.

He said AAAASF has collected peer review and unanticipated event reports for over a decade. The resulting statistics indicate accredited outpatient settings are as safe as or safer than published hospital safety rates.

“With more than 20 million patient procedures in the AAAASF dataset, there are reliable statistics showing sequelae and mortality rates lower than the inpatient setting,” said Nahai. “In fact, CDC found on any given day about one in 25 hospital patients has at least one health care associated infection (HAI) for a total of 721,800 infections in 2011. About 75,000 patients with HAIs died while hospitalized. Given the recent emphasis on HAI and the increased exposure to illness patients face because of the hospital inpatient population, these cost saving measures may increase post-operative complications requiring more corrective treatment and expense.”

He added, “If physicians and patients migrate back to inpatient care, the delayed treatment resulting from having to wait for the hospital OR to become available would further degrade a patient’s condition and force him or her to take additional time off work. Restraining access to care will degrade the general wellness of the U.S. patient population and result in more expensive inpatient care.”

AAAASF Executive Director, Theresa Griffin-Rossi, said, “AAAASF is aware there are other issues related to physician reimbursement and the legality of such plans. Our mission, however, is patient safety. The prospect of increased patient risk and reduced patient access to timely care is disturbing enough for AAAASF to oppose health plans excluding outpatient surgery.”

She added, “The rationale that these plans offer improved coverage for previously uninsured workers is invalid because the plans render employees ineligible to buy subsidized policies individually on their state’s health exchange. While small businesses certainly must find creative ways to manage the potentially devastating costs of providing coverage, doing so in a manner that reduces employee options and increases out-of-pocket expenses, is not an acceptable solution.”

About the AAAASF
The American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF) was established in 1980 to standardize and improve the quality of medical and surgical care in outpatient facilities and assure the public that patient safety is top priority in an accredited facility. More than 2,300 outpatient facilities are accredited by AAAASF, one of the largest not-for-profit accrediting organizations in the United States. Surgeons, legislators, state and national health agencies and patients acknowledge that AAAASF sets the "gold standard" for quality patient care.

AAAASF programs include surgical, procedural, oral maxillofacial, international surgical and dental. AAAASF is also deemed by Medicare to accredit ambulatory surgery centers, rehabilitation and outpatient therapy agencies, as well as rural health clinics. For more information, visit http://www.aaaasf.org or Facebook, LinkedIn and Twitter.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Kim Kubiak
@kkubiak_44sMom
Follow >
American Association for Accreditation of Ambulatory Surgery Facilities
since: 08/2010
Like >
AAAASF

Visit website