ASCs’ reimbursement problem 

ASCs are historically reimbursed at lower levels than hospital outpatient departments, despite being considered by many in healthcare to be a high-quality and low-cost site of care. 

Advertisement

As operating costs soar, many leaders are concerned about how low reimbursements will affect their ability to meet margins. 

Here are five numbers illustrating ASCs’ reimbursement challenges:

3.1%. CMS’ finalized payment rate for ASCs in its 2024 final rule, a decrease from 2023’s 3.8% payment rate. 

58%. How much more medical procedures can cost at HOPDs as of 2022 when compared to a physician office or ASC, according to an analysis by Blue Health Intelligence, the Blue Cross Blue Shield Association’s data analytics company.

10%. The percentage increase in the cost of a diagnostic colonoscopy at ASCs between 2017 and 2022, compared to 17% at HOPDs, according to the Blue Health analysis. 

33%. The amount by which adjusted reimbursement for GI procedures decreased on average from 2007 to 2022, according to a study published in the American Journal of Gastroenterology

55%. How much higher U.S. hospitals’ facility fees for colonoscopy procedures covered by private health insurance are than those at ASCs as of May 2023, according to a Johns Hopkins Bloomberg School of Public Health study published in JAMA Health Forum.

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.

Register to Attend Webinar

Is ambulatory care healthcare’s big margin engine? 4 leaders weigh in

Wednesday, July 29
1:00 PM - 2:00 PM CDT

Presenters: Joe Ganley, athenahealthJeffrey Flynn, CASC, Gramercy Surgery CenterBryan Tsao, Access Center, Loma Linda University HealthJason Zepeda, Northridge Hospital Medical Center, CommonSpirit HealthGreg DeConciliis, PA-C, CASC, Boston Out­Patient Surgical Suites

Advertisement

Next Up in ASC Coding, Billing & Collections

Advertisement

Comments are closed.