Association touts savings with ASCs
Medicare would save $1.5 billion in 2005 if cases submitted on hospital outpatient department (HOPD) claims were instead submitted on ambulatory surgery center (ASC) claims, according to a new study conducted for the Federated Ambulatory Surgery Association (FASA) by The Moran Company in Arlington, VA.
The study examined actual 2003 Medicare claims that included at least one surgical procedure payable in both ASCs and HOPDs. About 5 million HOPD claims were identified as having at least one procedure Medicare would reimburse if performed in an ASC. These claims were then re-priced according to 2005 payment rules for each setting. There were almost 5 million claims indicated from HOPDs that Medicare would reimburse for if they were performed in an ASC, according to FASA.
HOPD claims would total about $4.4 billion, whereas the total for the same claims in an ASC would be about $2.8 billion, FASA reports. These claims averaged $891 in the HOPD and $571 in an ASC, a difference of $320 less per claim in an ASC, the association says.
The primary reason for the payment differential between ASCs and HOPDs, accounting for about 85% of the difference, is the variation in payment rates, FASA says.
"This study demonstrates that ASCs are making a major contribution to helping Medicare limit its costs and could do much, much more," says Kathy Bryant, executive vice president of FASA. "The bottom line is that rather than freezing ASC rates, Congress should be encouraging the development of more ASCs and encouraging doctors and patients to perform more procedures in them. The savings can be used to meet other health care needs."
Matt Fenwick, a communications specialist with the American Hospital Association in Washington, DC, says, "We feel that patients treated by hospital outpatient departments are sicker than those treated by ambulatory surgical centers." That statement is supported by the Medicare Payment Advisory Commission in a recent study conducted for them by the Rand Corp., he says. (Editor’s note: To see a copy of the report, go to www.medpac.gov and search for "Rand.")
"It is for this reason that we feel the study is not a true apples-to-apples comparison," says Fenwick. "In addition, hospitals have costs associated with the care they provide that ASCs do not, like providing 24/7 emergency departments and added regulatory costs."
Medicare would save $1.5 billion in 2005 if cases submitted on hospital outpatient department (HOPD) claims were instead submitted on ambulatory surgery center (ASC) claims, according to a new study conducted for the Federated Ambulatory Surgery Association (FASA) by The Moran Company in Arlington, VA.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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