Package more, pay less
With ambulatory surgery center (ASC) payment rates averaging about
half of hospital outpatient department (HOPD) rates, the problem is
exacerbated if ASCs use the drug more frequently than HOPDs. In
many cases, it could be economically unfeasible for ASCs to host
cases if they're not paid separately for drugs.
Legislation that allows pass-through for 5 years won't solve the
problem, it will simply delay it. If CMS believes the drug functions as
a supply when performed in a procedure or surgery, it will eventually
package the drug into the reimbursement rate. True, it's nice to have
an extra couple of years of pass-through payment, but it would be bet-
ter to have adequate reimbursement for the long haul. But the trend at
CMS has been to package more and to pay separately for less, so per-
manently reversing this policy remains an uphill battle.
OSM
Ms. Newbury (knewbury@ascassociation.org) serves as regulatory counsel
for the Ambulatory Surgery Center Association in Alexandria, Va.
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