12/13/12

ASC Behavior and Payment Disparity

Outpatient surgery in an Ambulatory Surgery Center (ASC) costs much less than in an outpatient hospital setting or ASC owned by a hospital.  The gap has been growing due to the need for ASCs to compete and be efficient, and regulations and rates as defined by the largest payer in the country, Medicare.

ASC reimbursement rates vs. rates for hospital owned surgical centers (HOPD) went from 84% in 2008 to a proposed 57% in 2013. 

I would argue that hospital rates are artificially inflated and inappropriate to use as comparison to a fair rate for services provided in an ASC.  It is an artificially denominator.  Still, for a surgical center, there should be no difference in reimbursement based on who owns it.  There is a trend for hospitals to purchase ASCs because they can flip them to hospital owned HOPD status and get the much higher reimbursement from Medicare.


This is just illogical and a perverse incentive that's costing our healthcare system and Medicare hundreds of millions of dollars annually. 

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