Congress Tackles Surgical Reimbursement Discrepancies

By Jonathan Springston, Editor, AHC Media

A pair of federal lawmakers this week introduced legislation that addresses how the Center for Medicare and Medicaid Services (CMS) sets reimbursement rates for hospital outpatient surgery centers (HOPDs) and ambulatory surgery centers (ASCs).

Currently, Medicare pays ASCs an average of 49% of what it pays HOPDs for the same procedure, down from 89% in 2003, figures from the Ambulatory Surgery Center Association (ASCA) show. ASCs perform the same procedures as HOPDs, only at a lower cost, the association says, thereby saving taxpayers millions of dollars. The group argues the unbalanced reimbursement structure harms ASCs economically, often forcing these centers to sell to hospitals, which in turn transform the facilities into HOPDs.

“The current reimbursement structure is illogical and unsustainable. When ASCs and HOPDs provide the same outpatient surgical care, Medicare reimburses ASCs at a significantly lower rate than HOPDs, due in part to CMS using a different—and inappropriate—measure of inflation in the ASC setting,” ASCA CEO William Prentice said in a statement.

Introduced with bipartisan support, the Ambulatory Surgical Center Quality and Access Act of 2017 would require CMS to publish relevant quality data so patients can compare across different service sites, give an ASC representative a voice in CMS’ decision-making panel regarding outpatient payments, and provide more transparency by requiring CMS to publish which criteria led to the exclusion of a certain procedure from the ASC-approved list.

For more detailed information about this legislation and what it means for the industry, be sure to check out future issues of Same-Day Surgery.