• E-mail
• Print
• RSS

ASCs in the news: Pennsylvania physician-referral study disputed

Ambulatory Surgery Reimbursement Update, April 1, 2008

Last week's ASRU reported on a study published on the Health Affairs Web site, concluding that physicians send more privately-insured patients to ASCs while sending Medicaid enrollees to HOPDs. (To read last week's story, click here.)

A response to the study by Craig Jeffries, Esq., former executive director of the American Association of Ambulatory Surgery Centers, appeared on the Health Affairs Web site on March 21. Jeffries disputes many of the study's conclusions. Physician-owned and for-profit ASCs are treating a majority of their Medicaid referrals, according to Jeffries. In addition, employer-funded insurance and Medicare realize savings for every patient treated at the ASC rather than the HOPD: savings that help safety-net hospitals.

"These hospital outpatient procedures in the study.reflect a wide range of services that ASCs simply cannot provide because of state or federal laws and regulations. It would have been better to compare procedures that can be performed in both the ASC and HOPD," Jeffries says in his response. Further, what is true in Pennsylvania may not be true elsewhere. Jeffries cites other states, including Massachusetts and Utah, whose regulations prohibit ASCs from treating Medicaid patients.

When ASCs send their sicker patients to HOPDs, it may reflect good clinical decision-making by ASCs, rather than profit-motivated thinking. But according to Jeffries, the study does not analyze that possibility.

To read Craig Jeffries' letter, click here.

• E-mail to a Colleague
• Print
• RSS
• Archive