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| AAASC Offers Medicare Payment Calculator
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As ambulatory surgery centers re-evaluate their business strategies in the new light of CMS's revisions to Medicare's ASC payment system, industry advocate AAASC is providing a free, Web-based calculator to assist facilities in understanding the impact the new reimbursements will have.
According to the organization, the calculator can generate the payments that ASCs will receive for their current procedures, new procedures and device-related procedures for 2008, the year the new payment system will take effect, through 2011, when its transition will be complete.
The financial projections - which are based on the latest CMS data and subject to change, the organization warns - are searchable by CPT or HCPCS numbers and adjustable for local wages and conversion factor.
The calculator is just one item in AAASC's Web resources covering the revisions to Medicare's ASC payments, which also include a summary of the new payment rules, CMS's original documents and data and a forum of frequently asked questions.
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| GI Specialists React to Medicare Payment Cuts
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The new ASC payment rate will hit GI centers particularly hard. The current rate for a diagnostic colonoscopy performed at an ASC is $446. The payment will drop to $427.76 next year and, barring any late changes, will level out at $373.04 in 2011, according to the American College of Gastroenterology.
"Clearly, this rule will not let us stay sustainable," says Edward Cattau Jr., MD, chairman of the ACG's national affairs committee and a physician at Memphis Gastroenterology Group, PC, in Germantown, Tenn. "We looked at our costs here, and we have a very efficient unit, but after this rule goes into effect we'll be reimbursed at 15 percent below the costs."
It won't only be physicians who are hurt, says Sarkis Chobanian, MD, a staff physician at Gastrointestinal Associates, PC, in Knoxville, Tenn. "My fear is that smaller ASCs will fold, thus denying patients a choice and forcing them back to hospital outpatient departments," he says.
"What is ironic," he adds, "is that Congress passed a Medicare colon cancer screening benefit in 1998 and has studies showing that not enough Medicare beneficiaries are taking advantage of it, and then CMS is proposing regulations that will result in diminished access for these potentially life saving procedures."
Ronald Vender, MD, of the Gastroenterology Center of Connecticut in Hamden, says the cuts are arbitrary and unreasonable. "We can't just lower expenses in our ASCs, because we have the fixed cost of rent, staff salaries and expensive equipment," he says. "We will likely restrict our numbers of Medicare patients, lower the volumes in our centers and lay off some staff to offset the loss in revenues, which may require smaller facilities around the country to close."
In a public conference call on July 31, CMS officials explained that the rate reduction would be ushered in incrementally, as follows:
In 2008, payment rates for procedures will be a combination of 25 percent of the new rate and 75 percent of the current, 2007 rate;
In 2009, the rates will be 50 percent of the new and 50 percent of the 2007 rates;
In 2010, the rates will be 75 percent of the new and 25 percent of the 2007 rates; and
In 2011, the rates will represent 100 percent of the new rates.
During the conference call, the CMS officials suggested that the four-year transition would give ASCs time to change their case mixes. But Dr. Cattau argues that in most states it won't be as simple as just adding orthopedic procedures. "We have a certificate of need that says we can only do gastroenterology and endoscopy work," he says. "We don't have the option to change our payor mix."
An audio replay of the conference call is available at CMS's Open Door Forums Web site.
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| Report: Specialty Hospitals Outperform Generals in Hip, Knee Replacements
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It's no surprise that a study appearing in the August issue of the Journal of Bone and Joint Surgery reports that specialty orthopedic hospitals are targeting healthier and wealthier patients as compared to general hospitals. However, the fact that researchers discovered specialty hospitals showed better patient outcomes following hip and knee replacement surgeries is worth noting.
"We suspected that specialty orthopedic hospitals were selecting low-risk patients for admission and that is what our analysis found," says Peter Cram, MD, assistant professor of internal medicine at the University of Iowa's Roy J. and Lucille A. Carver College of Medicine and the study's lead author. "But we also found that complications were less common in specialty hospitals even after accounting for the types of patients each hospital admitted - this was quite surprising."
The researchers examined Medicare beneficiaries who had hip-replacement surgery (51,788 patients) and total knee surgery (99,765 patients) in 38 specialty hospitals and 517 general hospitals between 1999 and 2003. After adjusting for patient characteristics and procedural volume, patients having surgery at specialty hospitals showed a 40 percent lower risk of post-op complications.
Dr. Cram says the results suggest a potential edge in the quality of care provided by specialty hospitals. He cautions that the findings need to be replicated in younger patient populations with different approaches toward measuring surgical complications as well as additional focuses on patient satisfaction, costs and symptom relief.
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| News and Notes
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It's no surprise that a study appearing in the August issue of the Journal of Bone and Joint Surgery reports that specialty orthopedic hospitals are targeting healthier and wealthier patients as compared to general hospitals. However, the fact that researchers discovered specialty hospitals showed better patient outcomes following hip and knee replacement surgeries is worth noting.
"We suspected that specialty orthopedic hospitals were selecting low-risk patients for admission and that is what our analysis found," says Peter Cram, MD, assistant professor of internal medicine at the University of Iowa's Roy J. and Lucille A. Carver College of Medicine and the study's lead author. "But we also found that complications were less common in specialty hospitals even after accounting for the types of patients each hospital admitted - this was quite surprising."
The researchers examined Medicare beneficiaries who had hip-replacement surgery (51,788 patients) and total knee surgery (99,765 patients) in 38 specialty hospitals and 517 general hospitals between 1999 and 2003. After adjusting for patient characteristics and procedural volume, patients having surgery at specialty hospitals showed a 40 percent lower risk of post-op complications.
Dr. Cram says the results suggest a potential edge in the quality of care provided by specialty hospitals. He cautions that the findings need to be replicated in younger patient populations with different approaches toward measuring surgical complications as well as additional focuses on patient satisfaction, costs and symptom relief.
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