2 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9
A
mbulatory surgery center payment rates as a percentage of
the hospital outpatient department rates have steadily
declined over the years. In 2003, procedures performed in an
ASC setting cost Medicare 85% of the amount paid to HOPDs. That
figure dropped to 55% in 2014 and today stands at 50%. It's important
to note that ASC payments have not declined during this time. What
has declined is, on average, the percentage of HOPD payments the
ASC payments represent.
The No. 1 reason for the widening cost differentials? CMS uses sepa-
rate inflationary measures to determine reimbursement rates for
HOPDs and ASCs. For years, the Ambulatory Surgery Center
Association (ASCA) has been asking Congress and CMS to update
ASCs using the same inflation factors they used for HOPDs. And that
finally happened this year — one of several recent successes in our
efforts to level the reimbursement playing field between ASCs and
hospitals.
Leveling the Payment Field for Surgery
Narrowing the reimbursement disparities between ASCs and HOPDs.
Legal Update
William Prentice
• DIFFERENT INFLATION MEASURES For years, CMS has determined reimbursement rates for hospital outpatient depart-
ments and ASCs using 2 different measures of inflation, resulting in significant cost differentials.