HCFA lowers some Medicare physician fees
Final rule covers procedures performed in ASCs
Responding to concerns expressed by physicians and ambulatory surgery centers (ASCs), the Health Care Financing Administration (HCFA) has reduced the number of procedures that will be subjected to a lower physician fee when performed in a surgery center.
According to a final notice published in the Dec. 8 Federal Register, the "site-of-service differential payment" rule will apply to 127 procedures, including cystoscopy. However, another 25 procedures that were initially included in the rule have been deleted.1 (See list inserted in this issue.)
Under the rule, the practice expense relative value unit will be reduced by 50% for procedures that are performed in a physician's office more than 50% of the time. In other words, the portion of the physician's Medicare payment that is intended to cover overhead will be reduced because the physician used a surgery center. A site-of-service differential payment rule currently applies to inpatient and outpatient departments of hospitals.
Regulations are 'site neutral'
The differential typically reduces the overall physician's fee by 8% to 20%, according to Michael Romansky, JD, partner-in-charge of the health law practice of McDermott, Will, & Emery in Washington, DC, and legal counsel for the Chicago-based American Society of Outpatient Surgeons.
Physicians and same-day surgery managers had expressed concern that the rule provides an economic disincentive for physicians to perform certain procedures in an ASC. The physician's clinical judgment should be the deciding factor as to whether a procedure is performed in the office or an ASC, says Tom Stautzenbach, executive director of the American Society of Outpatient Surgeons.
"The regulations should be site-neutral," Romansky says.
Earlier this year, Baltimore-based HCFA relaxed its criteria relating to cases that could be performed in an ASC. Procedures that are performed more than 50% of the time in a physician's office previously were excluded from the ASC list, but they may now be handled in an ASC if the physician believes that setting is most appropriate for the patient. (For more information, see Same-Day Surgery, October 1995, p. 123.)
The "site-of-service differential payment" rule became effective Jan. 1.
Reference
1.60 Fed Reg (Dec. 8, 1995) 63,133 . *
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