Key ASC Legislation Introduced in US House of Representatives

Key ASC Legislation Introduced in US House of Representatives

WASHINGTON, DC, MARCH 30, 2017 — The Ambulatory Surgery Center Association (ASCA) today announced support for the newly introduced Ambulatory Surgical Center Quality and Access Act of 2017. 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—the lower cost provider of outpatient care.

US Representatives Devin Nunes (R-CA), John Larson (D-CT) and a bipartisan group of cosponsors introduced the bill today in the US House of Representatives.   

“The current reimbursement structure is illogical and unsustainable. When ASCs and HOPDs provide the same outpatient surgical care, Medicare reimburses ASCs at a significantly lower rate than HOPDs, due in part to CMS using a different—and inappropriate—measure of inflation in the ASC setting,” said Ambulatory Surgery Center Association Chief Executive Officer William Prentice. “Without a fix, the disparity between ASC and HOPD payments will continue to widen, potentially reducing access to ASCs and leaving Medicare beneficiaries with only higher cost options for their care and increased Medicare program expenses.”

The legislation also would:

  • require CMS to publish relevant quality data in a way that allows patients to compare quality across sites of service;
  • 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, more than 5,400 ASCs provided 7 million outpatient surgeries to Medicare beneficiaries. Currently, on average, ASCs are reimbursed by Medicare at 49 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.