MedPAC Proposes No Increase for ASC Payments in 2016

December 19, 2014

The Medicare Payment Advisory Commission (MedPAC) concluded their last meeting of 2014 today, proposing a recommendation that the ASC payment increase be eliminated in 2016. The commission also proposed a recommendation that ASCs be directed to report cost data. MedPAC will vote on these recommendations in January.

MedPAC is an independent congressional agency charged with advising Congress and the US Department of Health & Human Services (HHS) on Medicare payment policies, patient access and quality of care. Its recommendations are not binding on Congress.

In addition to proposing no increase in ASC payments, the commission recommended a 3.25 percent increase in payment rates for hospitals in 2016. Commission staff did note that certain factors indicate a slowing in the growth of ASCs, including the number of fee-for-service (FFS) beneficiaries served, the volume per FFS beneficiary and the number of ASCs and Medicare payments per FFS beneficiary.

According to commission staff, volume per FFS beneficiary increased by an average of 2.1 percent between 2008 and 2012 but increased only by 0.5 percent between 2012 and 2013. The staff also noted during their presentation that the shift in volume from hospital outpatient departments (HOPDs) to ASCs is no longer occurring. They remarked that although surgical volume is increasing faster in HOPDs than in ASCs, there is little change in the highest ASC-volume surgical procedures. Instead, the change appears to be due to a shift from freestanding offices.

“MedPAC’s payment recommendations never fail to disappoint,” said ASCA CEO Bill Prentice. “Even though MedPAC staff acknowledge the implications of the large disparity in Medicare’s ASC and HOPD payment rates, they go on to ignore them and recommend a 3.25 percent increase for the higher-cost, less-efficient setting and nothing for ASCs.”

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