4 Findings on ASC vs. HOPD Payments
The study examined payments in knee and shoulder surgeries in 23 states during 2011, which represent two-thirds of workers compensation benefits in the United States. Major findings included:
1. As conventional wisdom suggests, ASCs were less expensive than HOPDs in most states. The only consistent exception was Connecticut.
2. Most states studied employed different algorithms for determining payments for ASCs and HOPDs.
3. ASC network participation rates explained why ASC surgeries were more expensive than HOPD surgeries in some isolated cases.
4. Billing practices, or whether a facility billed for multiple surgical procedures during a single surgical event, also affected relative pricing. ASCs were more likely to bill for multiple procedures from a single surgical event, according to the report.
5. Workers compensation payments were lower at ASCs than in HOPDs in some states because of a lower fee schedule, most evident in Illinois, South Carolina and Texas.
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