Editorial Commentary: Increasing Patient Out-of-Pocket Expense Does Not Increase Value of Outpatient Surgery

In a value-based care environment, a goal is to favor outpatient surgery to reduce costs. Unfortunately, while outpatient (as compared to inpatient) surgery reduces overall cost, recent research shows that by including patient out-of-pocket expense (POPE), the proportion of overall cost born by the patient can greatly increase, which is unjust. The primary contributors to high outpatient surgery POPE are out-of-network facilities, out-of-network surgeons, and high-deductible insurance. Although historical focus on outpatient surgical cost reductions has been toward surgeon fees, anesthesia fees, facility fees, and implant fees, we must also focus on POPE. In the interim, it is essential to provide patients with price transparency, so that they understand their anticipated expenses and are not blindsided by cost burden.