The Federated Ambulatory Surgery Association (FASA) released a comparison of Medicare rates for procedures performed in ambulatory surgery centers (ASCs) with those for the same procedures when performed in hospital outpatient departments (HOPDs). This comparison shows that for most commonly performed procedures HOPDs would be paid significantly more than ASCs under the new systems that HCFA is implementing. According to FASA President Robert C Williams of Flagstaff, Arizona, the analysis shows that "even though HCFA talks about leveling the playing field, Medicare will continue to pay ASCs less than hospitals well into the future." Most importantly, because the beneficiaries copayment is tied to the reimbursement rate the beneficiary also pays more when procedures are performed in the hospital outpatient department.

The Health Care Financing Administration (HCFA) published a final rule implementing a prospective payment system for hospital outpatient departments (HOPDs) on April 7, 2000. This new system is similar to the one that HCFA proposes for ASCs. FASA analyzed the HOPD reimbursement rates in the final rule with the proposed rates for ASCs. In preparing this comparison, FASA analyzed the reimbursement rates of approximately 200 high-volume outpatient surgical procedures. This comparison showed that for virtually all specialties HCFA would pay HOPDs substantially more for performing the same procedure if the ASC rates are implemented as proposed in the June 12, 1998 Federal Register. In specialties that have more than five procedures in the analysis, the difference in payments ranges from HOPDs receiving 4% more for gastroenterology to 58% more for otolaryngology. The variance in individual procedures is even greater, ranging from 390% more for CPT code 67010, partial removal of eye fluid, to 53% less for several codes. It should be noted, however, for the 162 codes reimbursed in both settings, HOPDs received more reimbursement in 139 cases, more than 100% more in eight. Differences in how copayments are calculated result in actual variances in total payments that are even larger.

For each specialty, this document includes a chart comparing the proposed ASC payment rates with the final HOPD reimbursement rate. Each chart shows, by CPT code, the Medicare volume of the procedure, the ASC proposed rate as published in the June 12, 2000 Federal Register, the HOPD final reimbursement as published in the April 7, 2000 Federal Register, the difference between the two, and the percentage by which the HOPD payment exceeds (or is less than) the ASC rate. The overall difference in payments for these high volume procedures by specialty is included.

Copies of the survey are available from FASA for $20 and can be ordered online at www.fasa.org or by faxing ordering information including credit card information to 703-549-0976 or emailing it to ASC@ascassociation.org. Checks for orders may be sent to FASA at 700 N. Fairfax, Suite 306, Alexandria, VA 22314.