US. Lawmakers have introduced the Ambulatory Surgical Center Quality and Access Act of 2017, which aims to level the reimbursement playing field between freestanding ambulatory surgery centers and hospital outpatient surgical departments, reports the ASC Association.
Medicare currently pays ASCs 49% of the amount paid to HOPDs for the same procedures. That discrepancy, says the ASC Association, is forcing some surgery centers to sell out to local hospitals, which convert the facilities to HOPDs in order to secure higher reimbursements. The ASC Association believes the conversion of ASCs to HOPDs is costing U.S. taxpayers billions of dollars.
The disparity in reimbursements is steadily growing because of how CMS provides inflationary updates for surgery centers and HOPDs. The ASC Quality and Access Act proposes to transition ASC reimbursement updates from the Consumer Price Index for all Urban Consumers (CPI-U), which measures the rising cost of consumer goods, to the hospital market basket update, which is based on the increasing cost of providing medical care. The bill would also require CMS to post publically available side-by-side comparisons of ASC and HOPD quality metrics, which would include measures of quality care and copay amounts for ASCs and HOPDs in the same geographic area.
Surgery centers are also pushing for a seat at the policymaking table. The bill proposes to add an ASC representative to the Advisory Panel on Hospital Outpatient Payment, which is comprised of experts in hospital reimbursement and care delivery who advise the Department of Health and Human Services and CMS on updates made to the Ambulatory Payment Classification (APC) groups and their associated weights. CMS would also be forced to reveal the criteria used to determine which procedures are not permitted to be performed in ASCs.
"A new Congress and administration offer new opportunities to improve patient access to the high quality, cost-effective surgical and preventive services ASCs provide," says Bill Prentice, CEO of the ASC Association. "The Ambulatory Surgical Center Quality and Access Act would help ensure that ASCs remain a viable and affordable option for patients."