Outpatient Surgery Magazine

Predictable, Precise Incisions - November 2012 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 5 of 141

OSE_1211_part1_Layout 1 11/1/12 8:55 AM Page 6 EDITOR'S PAGE Dan O'Connor The Trouble With How You're Paid for Surgery Is it any wonder hospitals are acquiring ASCs and flipping them? W e agree that hospitals should be paid more than freestanding surgical centers for hosting the same procedures. Slightly more, to offset the costs of providing emergency services, caring for the indigent and being open 24/7. Not absurdly more, which is a fair way to describe a reimbursement model that pays the ASC $978 for cataract removal (CPT 66984) and reimburses the hospital $1,670 for the same procedure. Some will argue that today's payment system is dizzy from standing on its head for so long, that it rewards hospitals for being models of inefficiency and penalizes ASCs for being nimble and focused surgical factories that know their case costs to the dime, nickel and penny. Argue all you will about the inequity. A few more disturbing trends have emerged that have us puzzled and concerned. • Widening payment disparity. The ASC-HOPD payment disparity keeps growing, with no end in sight. Eight years ago, ASCs were paid on average 84% of HOPD rates, a number that seems reasonable to us today. When the new payment system was rolled out in 2008 (tinyurl.com/9buur73), the percentage had dropped to 65%, which is far too low. Under the proposed 2013 rates, the percentage will be further reduced to 57%, which is obscenely low. • Back to the hospital we go. The migration of cases from more costly HOPDs into lower-cost ASCs is slowing. Amazingly, reimbursement was off for 8 of the highest-volume ASC procedures last year. It's not because ASCs are no longer clinically appropriate settings for these cases. It's simply twisted 6 O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2012

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