Legislation to Promote Cost Savings, Patient Access to Outpatient Surgical Care Backed by ASCA



ALEXANDRIA, VA, March 18, 2015— The Ambulatory Surgery Center Association (ASCA) today announced support for the newly introduced Ambulatory Surgical Center Quality and Access Act of 2015, which is intended to preserve patient access to the high quality, cost-effective health care services that ambulatory surgery centers (ASCs) provide.

The bill was introduced today in the US House of Representatives by Congressmen Devin Nunes (R-CA) and John Larson (D-CT).

"The ASC Quality and Access Act is critical to the viability of ASCs and would ensure that Medicare saves more than $2.3 billion every year," said ASCA Chief Executive Officer William Prentice. "While ASCs and hospital outpatient departments (HOPDs) provide identical outpatient surgical care, ASCs are reimbursed by Medicare at a significantly lower rate than HOPDs and this payment disparity is on track to continue to increase. The current reimbursement structure is illogical and unsustainable."

Specifically, the bill would fix a flaw in current law that allows the Centers for Medicare & Medicaid Services (CMS) to use different measures of inflation for ASCs and HOPDs when setting rates, unfairly penalizing the lower cost provider. This improvement would prevent the migration of the procedures ASCs perform to the more expensive HOPD setting and encourage additional cost savings to Medicare and its beneficiaries. In addition, the legislation would require transparency in quality reporting and require CMS to publish relevant quality data in a way that is accessible to patients.

The legislation also would:

  • direct the Centers for Medicare & Medicaid Services (CMS) to add a representative of the ASC community to its Advisory Panel on Hospital Outpatient Payment because decisions made by the panel affect both HOPD and ASC facility fees and eligible procedures; and

  • require CMS to disclose which of six criteria triggers the exclusion of a procedure from the ASC approved list.

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About ASCs: ASCs are modern health care facilities focused on providing same-day surgical care, including vital diagnostic and preventive health care procedures such as colonoscopies. Last year, approximately 5,300 ASCs provided 5 million outpatient surgeries. Currently, on average, ASCs are reimbursed by Medicare at 55 percent of the amount paid to HOPDs for identical services. This disparity continues to grow from year to year. As recently as 2003, Medicare paid ASCs 86 percent of the amount it paid to HOPDS.

About the Ambulatory Surgery Center Association (ASCA): ASCA is working to raise awareness of the important role that ASCs play in the US health care system and the high-quality, cost-effective care that ASCs provide. For more about ASCA, go to www.ascassociation.org.


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