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According to Gabel and colleagues, the study of referral patterns in the Pittsburgh and Philadelphia areas revealed that physicians who refer the most patients to physician-owned ASCs disproportionately send privately insured patients there, while sending Medicaid enrollees to hospital outpatient departments. The Pittsburgh and Philadelphia areas were examined because Pennsylvania has both a large number of physician-owned ASCs and a requirement that all ASCs and HOPDs submit discharge abstracts.

However, Mr. Jeffries notes in his response, while the article "attempts to conclude that the safety-net hospitals suffer because physician-owners route low-paying/higher-cost Medicaid patients to hospital outpatient departments (HOPDs) ... [the] data clearly demonstrate that 55% of these Medicaid patient referrals go to the physician-owned ASC and 61% of these Medicaid referrals go to a for-profit ASC. Physician-owned and for-profit ASCs are treating a high majority of their Medicaid referrals!"

As a result, he writes, "One might better conclude that physician-owned ASCs have allowed patients, employers, and taxpayers to achieve substantial savings and thus continue the ability of employers and taxpayers to help fund cross-subsidized care at safety-net hospitals. ASCs are strengthening a critical funding source for safety net hospitals -- employers -- and thus Gabel et al. needs a Time Out because they are operating on the wrong [provider] site!"

Further, Mr. Jeffries' five-point analysis examines Medicare ASC Growth facility type, patient characteristics, Medicare impact and impact on other states. Read it here.