By Nick Vailas, CEO and Founder
of Bedford Ambulatory Surgical Center
The United States healthcare spending is nearly double per capita compared to the average of other wealthy nations, according to the Organisation for Economic Co-operation and Development’s (OECD) 2024 Health Statistics. However, compared to those same countries, the U.S. ranks at or near the bottom in terms of life expectancy, infant mortality, maternal mortality, heart attack mortality, diabetes management and asthma management.
Nick Vailas, founder and CEO of Bedford Ambulatory Surgical Center (BASC), knows that the future of healthcare is one where quality rises and costs go down. It’s something that he has strived to do in his own practice and pushed for within the entire industry.
To make progress in that direction, Vailas says that he’d like to see treatments offered in more appropriate settings, regulatory changes that encourage transparent and competitive pricing, more fairness in Medicare reimbursement rates between hospitals and independent freestanding practices and health insurance plans that aren’t sponsored by the employer.
Focusing on efficiency and excellence
Vailas sees the future of medicine as less about hospitals and more about treating and seeing patients in appropriate settings.
“You’ll see more facilities that are focused on specific services, and not a multitude of services, which will result in efficiencies, improved patient experience and lower costs,” he says.
In the Focus Factories model, centers are designed to perform a specialized set of procedures. Studies have shown that Focus Factories reduce patient wait times, lower complication rates, and deliver better outcomes by streamlining workflows and allowing providers to become experts in their specialties.
11 Washington Place
Bedford NH 03110
(603) 622-3670
bascnh.com
Over the past 31 years, BASC has been serving the good people of New Hampshire with distinction. To date, we have performed 231,339 surgical cases. There is a good chance you or someone you know who has received our care.
As policymakers debate solutions to make health care more accessible, one thing is for sure, independent surgical facilities reduce costs and aid in keeping independent private practicing doctors, independent. You as a patient have choices —seek independent doctors.
Countries that have adopted this model have seen measurable improvements in both quality of care and cost management.
BASC was named the top ambulatory surgical center in New England by Newsweek. Its core competencies include its surgical center with specialties in sports medicine and orthopedics; plastic surgery; gastroenterology; ear, nose and throat; and total joint replacement. It also has an imaging center and ophthalmology center.
Focus Factories have been slow to evolve in some areas due to regulations, like the “certificate of need,” that can restrict new or expanding healthcare centers and allow existing healthcare providers, like hospitals, to speak against them.
“Here in New Hampshire, we’ve been able to deregulate, not completely, but such that we’ve been able to build a significant capacity to offer outpatient care outside the hospital system,” Vailas said. “Most outpatient care in Massachusetts, Vermont, Connecticut, and Rhode Island still is being offered by hospitals.”
The hidden costs of care
When you order dinner, you see the cost of your meal on the menu. If you are getting a new car, you know the cost before you’re handed the title. But currently in healthcare, it can be a challenge or impossible to know exactly what you’ll pay.
In 2021, a price transparency law was passed to require hospitals to make their prices readily available for consumers. Those estimates can vary depending on your insurance carrier, insurance plan and the billing codes used. (Is your colonoscopy preventative or diagnostic?)
Even with the increase in available information, many hospitals provide data in formats that are difficult for consumers to interpret or compare, leaving patients without the clear, upfront pricing they need to make informed choices about their care.
“Patients are unaware of the costs of the care they’re about to receive until they get hit with the bill after their service has been received,” Vailas says.
Costs for care at hospitals or hospital outpatient departments, on average, are substantially higher than care from an ambulatory surgical center. Patients don’t always see those cost differences though because of how their insurance covers the procedures. Ultimately though, patients and employers who pay for insurance plans will pay for those higher costs through rising premiums.
Hospital-affiliated primary care doctors, who are the point of contact for referrals, are often directing patients to hospital-affiliated specialists, without looking into more affordable options. To shift away from the hospital system model of care to one of Focus Factories centered on controlling costs, patients need a better way to know what those costs are.
“We get there through greater pressure on developing true transparency on what a patient or an employer is going to pay for the service before receiving care,” Vailas said.
This lack of transparency underscores why Vailas believes individuals should have more autonomy over their health care and insurance choices.
Breaking the link between employment and health coverage
Once patients have a better understanding of how much their care costs them, they can make better-informed decisions about what they are paying for insurance.
More than half of insured Americans have employment-based health insurance. The other half are covered by Medicare or Medicaid (18.9% each), direct-purchase coverage (10.2%), or a military or veteran coverage plan (3.6%), according to data from the U.S. Census Bureau.
“I also see a shift away from employer-sponsored healthcare,” Vailas says. “Presently, one of the fundamental problems is that your insurance is provided by your employer, not yourself.”
People stay in jobs that they don’t want because they don’t want to risk losing coverage or changing coverage to find that their preferred providers don’t accept the new insurance plan.
“I see in the future, two systems of care, not one. You’re going to see the program offered by the government right now. It’s called the Exchange: Medicaid, Medicare,” Vailas said. “And then you’re going to see private health insurance. This is what’s happened in Europe.”
Vailas sees several implications of this model. One would be that individuals would better understand their insurance plans and know how to utilize their policy because they are the ones choosing the plan. The other would be that there is an increased personal responsibility to maintain good health because, similar to how crashes impact auto insurance, unhealthy habits could cause their rates to rise.
“We should be buying our own health insurance now. Your employer could actually help subsidize that, but it should be your policy,” Vailas says. “You own it yourself, and you can buy as much coverage as you want.”
BASC is working to modernize not just medicine, but the accessibility of health care. Patients need to be able to receive affordable, high-quality care, when they need it.
“With as much advancement in technology there has been in healthcare, we actually need to turn back the hands of time in the delivery of healthcare, where people have their own doctor,” Vailas said. “That has to become a reality.”
To learn more about BASC’s services and how they model the future of healthcare, visit bascnh.com.
