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ASCs in the news: ASC Association criticizes CMS on low payment rates for 2009

Ambulatory Surgery Reimbursement Update, September 30, 2008

The Ambulatory Surgery Center Association, based in Washington, DC, takes a dim view of CMS’ proposal to lower Medicare beneficiary payments to ASCs for 2009. In a September 11 letter Kathy Bryant, JD, president of the ASC Association, asked CMS to reconsider the OPPS rate, which is currently set for 59% of hospital outpatient departments (HOPD), down 4% from 2008. Bryant expressed concern over the widening gap in payments between ASCs and HOPDs. “Simply put, we do not believe that 59% of HOPD rates is either reasonable or fair to ASCs,” said Bryant.

According to the ASC Association, the ASC specialties most affected by the proposed OPPS rate are gastroenterology and pain management. Each accounted for almost 52% of Medicare ASC reimbursement in 2006, the ASC Association said. Each would see reductions of 6% in 2009. However, gastroenterology also saw a 5% reduction in 2008. “If the ASC-OPPS payment gap continues to grow, we are concerned that certain procedures or classes of surgical services will not be viable in the ASC setting,” said Bryant.

Among other suggestions in the ASC Association letter is a proposal that CMS eliminate the secondary rescaling of ASC relative weights. According to Bryant, this measure “inappropriately reduces payments to ASCs and further exacerbates the growing gap between ASC and HOPD payments....”

Two bills have been introduced in Congress to keep ASC payments rates at 75% of HOPDs. H.R. 1823 and S. 2250 would save Medicare “at least 25 cents on every dollar spent relative to HOPD rates,” said Bryant.

To view the entire letter, click here.

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