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

Washington, DC, September 24, 2015 –The Ambulatory Surgery Center Association (ASCA) today announced support for the newly introduced Ambulatory Surgical Center Quality and Access Act of 2015. This legislation would fix a flaw in current law that allows the Centers for Medicare & Medicaid Services (CMS) to use different measures of inflation for ambulatory surgery centers (ASC) and hospital outpatient departments (HOPD) when setting rates, unfairly penalizing ASCs, which are the lower cost providers.

Senator Michael Crapo (R-ID) with a bipartisan group of cosponsors, including Lamar Alexander (R-TN), Richard Blumenthal (D-CT) and Chris Murphy (D-CT), introduced the bill today in the US Senate.

“The ASC Quality and Access Act is critical to the viability of ASCs and would ensure that Medicare continues to save more than $2.3 billion every year,” said ASCA Chief Executive Officer William Prentice. “The current reimbursement structure irrationally uses a flawed inflation factor to update ASC payments under Medicare, resulting in an ever-increasing disparity in reimbursement between ASCs and hospital outpatient departments when providing identical care. Without a fix, the disparity between ASC and HOPD payments will continue to widen, challenging the ability of some ASCs to survive. Even CMS actuaries have acknowledged that the use of the consumer price index for all urban consumers (CPI-U) is unfair.”

The bill would help prevent the migration of 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 CMS to publish relevant quality data in a way that allows patients to compare quality across sites of service.

The legislation also would:

  • direct CMS to add an ASC representative 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.

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 5,400 ASCs provided 5 million outpatient surgeries to Medicare beneficiaries. 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 HOPDs.