Thanks to high-quality patient outcomes and cost efficiencies, more than 5,800 Medicare-certified ambulatory surgery centers provided an estimated 22.5 million procedures in 2018, and risk-adjusted studies confirm that the quality of care is equal to or better than that provided in hospital outpatient departments.
Thanks to clinical and technical advances, ASCs can now perform more types of procedures. Medicare, commercial insurers and patients can all benefit if more care migrates into these settings.
Medicare pays approximately 100% more whenever a procedure that could be performed in an ASC is done in a hospital outpatient setting. To take greater advantage of the benefits ASCs provide, CMS should:
- Ensure adequate payments for ASC procedures. To start, it is essential to use the same inflation measure to update both ASC and hospital outpatient rates each year.
- Eliminate the ASC weight scalar, a budget mechanism used to set ASC payments that perversely discourages procedure migration by reducing payments on the most commonly performed procedures, widening the gap between ASC and hospital outpatient reimbursements.
- Implement a co-pay cap in ASCs like the one in place for hospital outpatient departments. Without one, the patient’s share of certain higher-cost procedures in ASCs is higher than in hospital outpatient settings, even though the cost of the procedure itself is far lower. Patients shouldn’t be disincentivized from choosing the lower-cost setting.
- Allow ASCs to provide Medicare beneficiaries access to more of the procedures they are performing safely for privately insured patients and revise new language adopted in the Code of Federal Regulations this year that has the unintended consequence of blocking CMS from moving appropriate procedures into ASCs.
Some techniques private insurers are using successfully to incentivize appropriate patients to receive care in ASCs include:
- Making price and quality comparison tools easily accessible and user-friendly.
- Educating patients on how to become savvier healthcare consumers.
- Offering shared-savings incentives.
- Requiring preauthorization before patients get care in the more-expensive setting.
The extraordinary value ASCs provide to our healthcare system is clear. Policymakers, private insurers and others should be acting now to adopt policies that enable them to take fuller advantage of that value.