Transparency: The Value of Independent Facilities

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The previous articles in this series discussed quality as it relates to service and outcomes. Additionally, different aspects of value, such as full-burdened cost, were covered. Now that the reader has some idea of what to look for, it is time to discuss where to find value.

While value can be found in multiple places, most health care consumers do not have the ability to launch a major nationwide search or dig through hundreds of facilities. What follows are some generalizations that can be used to make the search as efficient as possible.

With advances in medical technology and techniques, one does not have to go to the major health centers to receive quality service and great value. Many elective surgeries can be, and are, performed regularly in ambulatory settings. As an example, we at Prairie Spine & Pain Institute have been performing spine surgeries; e.g., fusions and disc replacements, in an ambulatory setting for over ten years. These are great options for patients. The facilities are typically smaller and easier to navigate. Extremely ill patients are not treated there, so risks like infection are typically much lower in the ambulatory setting.

Another important advantage is that there is typically more surgeon control in the ambulatory facilities. This is true for independent facilities, as well as those affiliated with hospitals. This allows for more personalized and tailored care, with more decisions being made by medical providers instead of business administrators. Staff is generally constant, so efficiency is improved which helps cost as well as outcomes. There are often better nurse to patient ratios, so nursing staff can be more meticulous, and patients receive more immediate nursing assistance.

Even though ambulatory facilities are delivering more care and often experiencing higher patient satisfaction, the costs are typically much lower than the hospital setting. Greater efficiencies including staffing and resource management are contributing factors. Also, these facilities are specialized, and performing elective scheduled procedures allowing them to have predictable cases, thus leading to lower supply costs. Finally, the healthier patient population treated in the ambulatory setting uses fewer resources while in the operating room and prior to discharge. These advantages are passed along to the health care consumer to increase value.

In general, these reasons allow independent facilities hold a distinct advantage to provide high quality at lower cost. Additionally, market forces push independent facilities towards creating value. They do not have emergency departments or employed primary physicians funneling patients to them. The independent facilities also do not have the million-dollar advertising budgets of the large hospital systems. Therefore, they must produce a superior experience at a great price to be competitive and to stay in business. The health care consumer is prioritized, so the patient, rather than the insurance carrier, is seen as the customer. These locations are typically driven by local word of mouth and by patient research on the Internet.

Therefore, I would encourage you to research local facilities, especially those in an ambulatory setting for elective spine and orthopedic procedures. Certainly, the FMMA website ( is an important resource. Value with a great reputation must be present for these places to survive. Frequently, given the size of ambulatory facilities, discussions can be held with decision makers so that you can really learn about the services provided and those individuals providing the service. Access to decision makers also makes negotiation and contracting a smoother process. Hopefully, this provides insight as to where to get started. Next month we will summarize everything we have shared over the last few issues to provide a playbook for navigating spine and orthopedics in the free market.

Dr. Richard Kube

About Dr. Richard Kube

Richard A. Kube II, MD, FACSS, FAAOS, CIME is a fellowship trained spine surgeon and Founder/Owner of Prairie Spine & Pain Institute, in Peoria, Illinois. He also founded and owns Prairie Surgicare, an AAAHC certified surgical facility. He holds Board Certifications from the American Board of Spine Surgery, American Board of Orthopaedic Surgery and American Board of Independent Medical Examiners. His practice is dedicated to providing comprehensive operative and non-operative treatment for spinal ailments with a special interest in minimally invasive surgical techniques. Dr. Kube is also engaged in active research and education projects. His interests extend into strategic planning and entrepreneurship as he is Advisor to Twisted Sun Innovations, a Hydrogen energy company currently working on renewable energy solutions for the U.S. Department of Defense. Dr. Kube currently serves as clinical faculty at University of Illinois College of Medicine at Peoria.

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