US House Bill to Promote Cost Savings, Patient Access to Outpatient Surgical Care Backed by ASCA

WASHINTON, DC, June 25, 2013 — The Ambulatory Surgery Center Association (ASCA) is announcing its support for the Ambulatory Surgical Center Quality and Access Act of 2013, which was introduced in the US House of Representatives today. The new legislation, which is nearly identical to a bill introduced in the US Senate two weeks ago (S.1137), is intended to preserve patient access to the high quality, cost-effective health care services that ambulatory surgery centers (ASCs) provide.

US Representatives Devin Nunes (R-CA) and John Larson (D-CT) sponsored the House bill. The legislation also has the bipartisan support of 20 other members of the House who signed on as original cosponsors.

“The ASC Quality and Access Act would enable ASCs to continue saving Medicare more than $2.6 billion every year,” said ASCA Chief Executive Officer William Prentice. “The current reimbursement structure is unsustainable at best, and threatens patient access to high quality, cost-efficient care. 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. Without a fix, many ASCs could be forced to shut their doors or sell their facilities to hospitals, and patients will be driven to seek care at HOPDs. Because ASCs will be harder to access, patients could see their out-of-pocket expenses increase and the Medicare program could see its costs rise.”

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 implementation of a value-based purchasing (VBP) program to encourage collaboration between ASCs and the government while generating additional savings for the Medicare program and its beneficiaries.

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

  • create more transparency within the Medicare procedure approval process by requiring 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 25 million outpatient surgeries. Currently, on average, ASCs are reimbursed by Medicare at 58 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.