HHS confirms billions of cost savings tied to ASCs
ASCA: Data also reveals reimbursement issues
In a just-released report, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) found that outpatient surgical procedures that do not pose significant risk to patients performed in ambulatory surgery centers (ASCs) have saved Medicare more than $1 billion in each of the last several years. The report also said that they have the potential for even greater savings.
As a result of the cost-savings that ASCs offer, the report concludes, " Medicare saved almost $7 billion and beneficiaries saved an additional $2 billion during CYs 2007 through 2011. Also, Medicare and beneficiaries could save an additional $12 billion and $3 billion, respectively, during CYs 2012 through 2017."
William Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), said, "Ambulatory surgery centers can save Medicare and its beneficiaries billions more than we currently do, but policymakers need to be mindful of how we maintain our high quality. ASC reimbursement under Medicare needs improvement, and any plan to adjust reimbursements to providers or shift volume to take advantage of the high quality and efficient care in ASCs must take that into consideration."
Medicare could generate savings of as much as $15 billion for CYs 2012 through 2017 if the Centers for Medicare and Medicaid Services (CMS) reduces outpatient department payment rates for ASC-approved procedures to ASC payment levels for procedures performed on beneficiaries with low-risk and no-risk clinical needs, the OIG said.
OIG recommended that CMS:
• seek legislation that would exempt the reduced expenditures as a result of lower outpatient prospective payment system (OPPS) payment rates from budget neutrality adjustments for ASC-approved procedures
• reduce OPPS payment rates for ASC-approved procedures on beneficiaries with no-risk or low-risk clinical needs in outpatient departments;
• develop and implement a payment strategy in which outpatient departments would continue to receive the standard OPPS payment rate for ASC-approved procedures that must be provided in an outpatient department because of a beneficiary’s individual clinical needs.
CMS did not concur with the recommendations, OIG says.
Officials identified patients as high risk, low risk, or no risk on the basis of risk factor conditions such as age 80 and older, cancer, diabetes, heart disease, asthma/chronic obstructive pulmonary disease, renal failure, obesity, etc. A high-risk patient was defined as having two or more of these conditions. A low-risk patient was defined as having one of these risk factor conditions. Officials defined these risk factors by grouping chronic diagnosis codes and then identifying records of patients with discharges including these diagnosis codes.
The full OIG report is available at http://1.usa.gov/1k06h8x.
