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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
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